Children and Young Peoples Project

Children and Young Peoples Improving Access to Psychological Therapies Newsletter - December 2012

For more information please see: http://www.iapt.nhs.uk/cyp-iapt

Children and Young Peoples Project

Welcome and Introduction
Welcome to the December edition of the CYP IAPT newsletter. It has once again been an incredibly busy few months for everyone involved! Back in July we announced that the North-East and South-West collaboratives would be joining CYP IAPT. These two teams have been working extremely hard and effectively to get courses developed and approved, trainees recruited and IT systems ready for Routine Outcomes Monitoring (ROM). You can find articles on the South-West and North-Easts experiences of applying to CYP IAPT and establishing a collaborative on pages 5 and 8. Over the past few months, year 1 collaboratives have reflected on the lessons they learned and shared this wisdom with curriculum groups and their new colleagues. Updates from Reading and Lon- Professor Peter Fonagy don can be found on pages 6 and 7. Salford has been running ROM workshops, and National Clinical Lead for Children and Young on pages 9 and 10 we have feedback and an overview of this training.
Peoples IAPT

Congratulations to all the trainees, supervisors and service leads who have completed their training we know how hard you have worked, not just on the academic side but also to overcome practical issues as they arose in this first experimental year. We are enormously grateful for all your feedback. It has been invaluable in improving the courses and overall experience for year 2. We are planning a joint workshop in London at 1 pm on Friday 8th February 2013 for all those who attended the service leads course in years 1 and 2 please save the date in your diaries, further information will follow. Participation is at the heart of the CYP IAPT project, and the Greater Involvement, Future Thinking (GIFT) consortium, led by Yvonne Anderson, has been appointed to lead on this until 2015. Each collaborative has been assigned a contact in the GIFT team and bespoke solutions tailored to local needs are being developed. You can find further details about this on page 3. We would like to thank Sarah Brennan and her team at YoungMinds for the invaluable contribution they made to the first year of the programme. On page 4 you can find an exciting article about innovative methods of self-referral to guide our thinking in relation to CYP IAPT. A major intellectual, clinical and organisational challenge is integrating the new modalities, Interpersonal Therapy (IPT) and Systemic Family Therapy (SFT). Work is well underway and we hope to have draft curricula ready by the New Year. All this has been happening against a background of trying to improve on and expand the existing provision in line with our learnings from the first year. As of 1st December, all of our year 1 sites have moved to full ROM. Using ROM to enhance your therapeutic relationships and collaborative practice with the children, young people and families we serve is central to CYP IAPT. No one is in any doubt that this presents challenges to you and your services, but every time we meet with young people they tell us that being able to see and understand how things are going is not just helpful but demonstrates concretely our commitment to consider them as a full partner in a joint effort, rather than a passive recipient of treatment. As ever, we hope the newsletter will not only inform those who are already part of CYP IAPT, or hoping to join, but also encourage you to get in touch with your ideas and questions.You can find contact information on page 10. Have a wonderful break.

For more information please see: http://www.iapt.nhs.uk/cyp-iapt

Children and Young Peoples Project

New Team Members
We are pleased to introduce two new members of staff who joined the project over the summer.

Anne OHerlihy, Extended Scope Project Lead

I am delighted to be working with the CYP IAPT team to support CAMHS and their partners delivery of high-quality care for children, young people and parents/carers. Prior to this post, I worked at the Royal College of Psychiatrists Centre for Quality Improvement (CCQI), where I managed a number of CAMHS health service research projects (NICAPS, 2001; CIRS, 2007; COSI-CAPS, 2007) and quality improvement and accreditation programmes. During my time at CCQI, I helped to establish the Quality Network for Inpatient CAMHS (2001-2003). More recently, I managed (with professionals and stakeholders) the development of service standards for the safe and appropriate care of young people on adult wards (2009), a crisis and/or intensive response within community CAMHS for the Quality Network for Community CAMHS (2010), and practice standards for young people with substance misuse problems (2011). My primary role within CYP IAPT is to support the extended scope of the project, to develop and offer two further curriculum courses: interpersonal psychotherapy (IPT) for adolescents and systemic family therapy (SFT), and all other aspects of the programme with the CYP IAPT team.

Adriana Greco, Project Support Officer

Since July 2012 I have been working with Kathryn Pugh, the CYP IAPT Programme lead, and Anne OHerlihy, the new project lead, to provide administrative and assistance to workstreams within the CYP IAPT programme, ensuring a high standard of support to leads and managers, meetings and events. I previously worked in the pharmaceutical sector as Clinical Trials Associate for Cancer Research UK and at CeNeS Pharmaceuticals plc (a biotech sponsor drug company in Cambridge) providing project support for a number of clinical research studies, in particular on early Phase I and II trials involving diagnostic research. During my time at CeNes Pharmaceuticals I worked within the Clinical Development team which develops new therapies for chronic pain and neurological disorders.

For more information please see: http://www.iapt.nhs.uk/cyp-iapt

Children and Young Peoples Project

GIFT New Participation Lead
We are a partnership between Cernis and Associate Development Solutions (ADS) a core team of five people with a long, combined history of working in CAMHS, locally, regionally and nationally. We are well known as leaders of transformation in CAMHS and hold a passionate belief in the importance of positive change and renewal in CAMHS.The participation of children and young people is integral to how we work. In addition to the core team, GIFT has a range of partners, young associates and volunteers.

Yvonne

Fiona

Joe

Cathy

Jane

We are working with a range of professional partners including Youth Access, the National Youth Advocacy Service, Practical Participation, Right Here and Mellow. GIFT will also be working directly with young people (we are recruiting now) to ensure that they are able to influence the national CYP IAPT programme. Participation is a key strand across the whole of the CYP IAPT service delivery model, and the GIFT Partnership will ensure that young people are involved in the design, delivery and evaluation of the approach that we take. We will ensure an innovative, creative and robust approach to working in partnership with young people: we use a youth work model that focuses on developing participation to the level where young people will be the drivers of change and will make key decisions about their wellbeing and their services, supported by the adults around them. The model will enable children and young people to develop their skills and give them support to increase their potential and to access wider life opportunities.

Find out how MyAPT can help you embed participation in your CYP IAPT service
MyAPT (www.myapt.org.uk) is a membership site that helps young people, mental health professionals, CAMHS partnerships and the universities that train them to embed children and young peoples participation in the way psychological therapies are delivered. It also has relevance for non-CYP IAPT sites and related professionals who want to embed participation. The benefits By using this site in conjunction with tailored support from the GIFT Partnership you will: l Feel more confident about how to involve young people, or be involved as a young person; l Have more skills and strategies for enabling user participation; l Experience an easier journey to embedding participation as a valued part of your everyday practice; l Improve young peoples satisfaction with your services. For more information please see: http://www.iapt.nhs.uk/cyp-iapt
3

Children and Young Peoples Project

Improving Access: Self-Referral
The South London and Maudsley NHS Foundation Trust (SLAM) has been implementing self-referral to CAMHS, both through the normal systems, and also through drop in services and self-referral groups. Here, Paul Calaminus, the Service Director, focuses on one such approach and sets out the challenges and successes.

Self-referral: The ability of a parent or child to refer themselves into the CAMHS service without needing a professional referral to access service
The CAMHS Discover workshops offer manualised treatment for teenagers with anxiety and depression. They are run in schools, sports centres, youth clubs and community centres and we have seen around 70 young people so far. We have put significant effort into consulting young people about self-referral and publicity/signposting, working with the Teenager Advisor Group. The majority of young people we have worked with have been supportive of the idea of self-referral, and we have designed specific publicity material which has been spread across the local area through a website, Facebook, the radio and flyers. We have also visited schools and youth clubs to talk to young people about the service. Programmes are given titles such as How to manage stress and How to keep it together in an imperfect world in an attempt to make the process less stigmatising and more accessible. We have also added an option of semi self-referral where we give groups of young people (particularly classes in schools) information about the workshop programme and its benefits and then encourage young people who are stressed to attend an information meeting with us. They can then decide if they want to attend the workshops. This is time-consuming for the team and schools, but it does build a partnership with staff and helps young people to come forward to access the service. This is particularly important because, overall, we believe that teenagers in particular seem less likely than adults to independently seek psychological help/therapy due to a combination of developmental reasons (e.g., not able to take action to resolve problems), practical reasons (e.g., travel) and stigma. Importantly, this route remains a self-referral one it is not necessary for the young person to be referred by anyone else. Overall, feedback from the young people about the process of self-referring has been positive, as has their feedback about the impact of the intervention (which is CBT-based) and the clinical outcomes achieved. For all young people we have been clear that the service is provided by SLAM and that professional clinical staff are involved. As part of initial conversations with young people, and within the group, we have emphasised issues of confidentiality and addressed perceived risks of stigmatisation and bullying. As with other drop in and self-referral projects, record-keeping has been a governance issue. In addressing issues of stigma, we have kept records separate from those of the main Trust electronic patient record, unless a young person has needed onward referral to other Trust services. Across all drop-in services run within CAMHS, whether these are GP, street or community based, we have found this to be a necessary precondition to effectively engaging with young people and addressing issues of stigma.We have, of course, kept appropriate clinical records. In summary, the provision of self-referral routes has been effective in engaging some young people, with positive impacts on their mental health and their experience of using CAMHS services. Self-referral initiatives have also proved an effective way of providing a more community based service in alternative settings. For more information please see: http://www.iapt.nhs.uk/cyp-iapt
4

Children and Young Peoples Project

Update from the South-West
Catherine Gallop and Ian Frampton from the South-West collaborative describe their experiences of bidding to join the CYP IAPT programme, and how all the stakeholders in the new collaborative have come together around their shared values.

Devon, Plymouth, Torbay CAMHS, Exeter University and Young Devon have joined to create a new SouthWest IAPT collaborative. We are a diverse group of practitioners, managers, commissioners, training providers and youth participation specialists who all have a passion for working with young people and their communities. Providing a service across a largely rural and coastal county, but with three major urban centres, requires understanding of the service pressures across different geographic and demographic areas, which range from high deprivation to relative affluence.
Exeter University

When shared passions come together there is potential for great creativity, but also for conflict unless shared aspirations can be agreed. This was never more evident than when considering our own values in the light of the values and vision of the CYP IAPT programme, and having to agree a common way forward. Our self-assessments gave us a good basis from which to put together our bid. It was important for each of us to appraise honestly our services and educational provision in the light of what CYP IAPT would be asking of us. In addition to our core values, we each needed to acknowledge our weaknesses and empha- Catherine Gallop, sise the strengths each service would bring to the collaborative. And, although Programme Lead enormously diverse, the partners are complementary, and are learning how to collaborate across organisational boundaries. At the heart of putting together a successful bid was high-level endorsement, not least the strong contribution from our childrens commissioner, as well as trusting, open and honest relationships across the leadership group. Although the memory of the final presentations is a blur of huddles, late-night telephone conversations, last-minute dashes across London, and fleeting encounters with other CAMHS teams in the foyer, one thing was clear and heartening: everyone in Ian Frampton this group went the extra mile to make the bid happen. Parenting Lead So what would be our advice to others preparing to join CYP IAPT? Well, start with an honest self-appraisal of your own services, develop strong, open relationships with your partners, ensure you have endorsement at all levels from service users to commissioners, be prepared to go the extra mile, and dont panic if your PowerPoint lets you down on the day!

For more information please see: http://www.iapt.nhs.uk/cyp-iapt

Children and Young Peoples Project

Update from Reading
It is an exciting time for Reading, as year 1 trainees are returning to their workplaces to embed their learning for the benefit of children, young people and parents. 19 CBT trainees, six parenting trainees, seven supervisors and 18 leadership delegates hope to graduate in the Summer of 2013. We gained new partners for Year 2 back in July this year: Berkshire Healthcare NHS Foundation Trust, South Essex Partnership NHS Foundation Trust, and Central and North West London NHS Foundation Trust. We have also been fortunate to be joined again by our year 1 partners: 2Gether Trust, Gloucester, and Bournemouth and Poole Children and Young Peoples Emotional Health and Wellbeing Service, and Dorset Healthcare University NHS Foundation Trust. We are looking forward to working with partners old and new and sharing the lessons learned from year 1. We were busy with interviews during the summer and have recruited 35 new trainees, eight supervisors and 22 service leads for year 2. The leadership and supervisors courses started in November and the trainees all start at the University of Reading in December. We have been changing the way we record information and will soon be moving to a new system which will give us remote access and will provide clinical staff with instant feedback about how the children and young people are getting on. We have also been trialling the use of iPads and hope this latest technology will help us collect information about how the training is affecting the young people we look after. As part of the leadership programme, year 1 graduates are working on projects around self-referral and implementation of routine outcome measures across whole services. They are also currently working on pilots to ensure lessons learned in Year 1 are taken into account prior to full implementation. In addition, Year 1 leadership graduates will also be coaching Year 2 leadership delegates. Our young people been creating two films to raise awareness of CYP IAPT. A group of around 20 initially met with a production company in May and since then have been producing two films, one aimed at younger children and another aimed at adults. The young people have worked extremely hard to storyboard the films, draw the graphics, record the voiceovers and film footage. They have learned many new skills and have worked brilliantly as a team.The penultimate versions of the films were premiered at the University of Readings end of year 1 celebration event on 5th December and the young people are looking forward to getting together for the wrap party. The Young people from Reading are films will be made available for all to view early in the New Year. producing two films

What amazed me was how much weve done and that from our ideas to start with, we now have something people can watch. I cant wait to see my name at the end!
Young participant

For more information please see: http://www.iapt.nhs.uk/cyp-iapt

Children and Young Peoples Project

Update from London
The past few months have involved considerable change within the collaborative, most significantly, an expansion to 16 partnerships, which include 20 CAMHS services, 11 local authorities and 13 voluntary sector organisations. Geographically speaking, the collaborative reaches from Cambridge and Hertfordshire in the north to West Sussex in the south, with 14 London boroughs in between. This is in addition to the coordination needed between two uni- Map of the London collaborative and partnerships versities! Coordinating this extensive network of services is a daunting task, but we are developing increasing knowledge and expertise about what structures we need to make this work, and also strengthening relationships between the partnerships and universities. This is all coordinated and supported by a full-time project manager. Additionally we are working closely with London Strategic Health Authority (SHA) in thinking about how to support non-CYP IAPT CAMHS services in preparing for applications next year and/or developing their services in line with IAPT principles. The second-year partnerships have almost completed appointing new members of staff as backfill for trainees. This expansion has meant a significant enlargement of the Steering Group, which has been reconfigured for collaborative problem-solving of specific contemporaneous questions, the biggest of which is how to implement systems for collecting data from service user feedback and outcome measurement tools which increase efficiency, effectiveness and mobility and bring the 90% target into range. A close second is working up a widely feasible solution to the problems faced by partnerships in supporting their trainees to bring clinical session video footage to training sessions; we have been working closely with Meganexus to address this since the summer in anticipation of the second year of therapy trainees starting in January. We are particularly proud of the developed content and structure of our courses, delivered to the partnerships jointly by University College London and the Anna Freud Centre, and Kings College London. This is being achieved through consultation with students in year 1, our colleagues in collaboratives around the country via the centrally coordinated curriculum groups, and based upon our experiences in this first year, which will soon deliver the first trained cohort of therapists. Taking up the opportunities offered by the central team to expand training provision, existing expertise within the partnerships is being drawn on to develop the teaching groups and bring a greater richness of clinical and management experience alongside the practical approach of implementation science to provide greater support to service leaders on site. This has included recruiting tutors for the manager course from first-wave partnerships. For more information please see: http://www.iapt.nhs.uk/cyp-iapt
7

Children and Young Peoples Project

Update from the North-East
We consist of Northumbria University Faculty of Health and Life Sciences, Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH) and Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). Applying for and then preparing to be a site for CYP IAPT has been hectic at times, but has also been an enlightening and empowering journey for our organisations, from initial construction of the bid (March 2012), to university validation of academic programmes (November 2012). Universities often involve stakeholders when planning professional development for practitioners, but Northumbria has achieved a much deeper level of engagement when applying for CYP IAPT and planning courses. CYP IAPTs whole systems transformational approach contrasts with the usual process of services seconding students to courses. It is often assumed that after completing training courses students return to practice with developed skills, and service improvement logically follows. Whilst this may be true, the service transformation agenda embedded within CYP IAPT makes sure that improvement is an explicit rather than an implicit assumption. Collaborating trusts have been working closely with university providers. Workforce and staff development are important issues for effective service transformation. The CYP IAPT approach has led to a more systematic consideration of workforce development. Supervisors and service leads have already begun training and the main programme is due to start in January 2013, with participants looking forward to their training whilst, of course, being slightly apprehensive about the journey ahead.The collaboration between organisations will not cease once planning is complete, but is integral to the main academic programme. Trust partners have gained a useful insight into the processes involved in operationalising an academic programme from conceptual curriculum to tangible delivery. At the validation event we were praised for our collaborative approach to development. Young people were actively involved in the recruitment of students and this input has been a delight for the university and both partner trusts. For us this experience underscored the importance of ensuring participation throughout planning and implementation. The national project team has been a tremendous source of support, and existing collaboratives have kindly shared their experiences and ideas. The process has not been without hitches, but strong relationships have been forged between three like-minded organisations that are future-facing and embrace transformational change in the pursuit of high-quality services. This has resulted in clear mutual expectations during the application and project initiation stages, laying a firm foundation for collective problemsolving as we move to implementation.

For more information please see: http://www.iapt.nhs.uk/cyp-iapt

Children and Young Peoples Project

ROM Workshops in Salford
Routine Outcomes Monitoring (ROM) is a key element of the successful implementation of CYP IAPT. Salford collaborative therefore decided, with the support of NHS North West, to run a series of workshops on ROM for all partnerships to raise awareness and support implementation. The workshops had 5 aims: 1) to raise awareness of the key elements of CYP IAPT; 2) to ensure a baseline knowledge of CYP IAPT across the workforce; 3) to introduce and increase awareness of nationally agreed CYP IAPT measures; 4) to provide an opportunity to experience and test application in practice; and 5) to identify relevant internal and external networks and the necessary resources for successful implementation. The one-day workshops were delivered to a total 152 staff members. The majority were attended by a senior manager, which ensured visible strategic ownership and commitment to the successful implementation of CYP IAPT. In several cases data managers attended, providing up to date information on the progress of the organisations IT resources and infrastructure.They were also able to provide insights into the challenges and potential local solutions with regard to data collection, input and analysis. After the workshops, a survey was distributed and an analysis of participants responses showed that more than 90% found the training very useful (see below):

Completed questionnaires Q1 Awareness of CYP IAPT transformation and its aims (Aims 1 & 5) Q2 Awareness CYP IAPT Routine Outcome Measures (Aims 2, 3 & 5) Q3 (Activity 1) Using practitioner forms, SDQ, RCADS, clinical bands (Aim 4) Q4 Awareness of goal-based outcomes (Aims 2, 3 & 5) Q5 (Activity 2) Using GBOs ORS, SRS (Aim 4)

Positive (%) Neutral (%) 91 93 94 94 95 9 7 4 5 3

Negative (%) 0 0 1 1 2

Five key themes emerged from the survey: 1) Content: those attending recognised and commented upon the amount of information that needed to be presented, and did not realise the range of outcome measures being considered for use. 2) Information technology: there were significant concerns about services IT capacity and the lack of access to suitable hardware. IT infrastructure was seen as a major factor affecting the services ability to carry out ROM. 3) Effective communication: the majority of those attending the workshops were aware of CYP IAPT and welcomed the information provided, acknowledging the value of the key principles of CYP IAPT. For more information please see: http://www.iapt.nhs.uk/cyp-iapt
9

Children and Young Peoples Project

4) Infrastructure: The ability of the current CAMHS infrastructure to support the implementation of ROM and CYP IAPT generally was a regular subject of discussion. Concerns were raised in particular about how to include ROMs live in session due to increased service level pressures and expectations. 5). Moving forward: a key theme in all of the workshops delivered was a willingness of the workforce to support the implementation of the key elements of CYP IAPT, recognising that many of the deliverables were, in fact, markers of an effective CAMHS. In summary, ROM requires a cultural shift for many organisations and requires a high level of support for successful implementation. We have found a significant degree of enthusiasm for the use of ROM in practice. Ensuring effective communication to the entire workforce is one of the most challenging aspects of CYP IAPT. The project is complex and ambitious, and its continued successful implementation will to a great degree depend upon the goodwill of the committed workforce. Acknowledgements We would like to acknowledge the support of all the partnerships within the Manchester Learning Collaborative and thank all those who attended the workshops for the valuable contributions made.

Coming soon
l Special l ave S

edition: a newsletter dedicated to outcomes and evaluation is coming out in January.

the date: we are hosting a joint workshop for all those who attended the service leads course in year 1 and 2 in London at 1 pm on Friday 8th February 2013. Further details to follow.

Contact Us and Our YouTube Channel

The CYP IAPT YouTube channel is up and running. You can watch the presentations from the July conference and some videos on participation by clicking this link. If you have any interesting videos relating to the project that you would like to share, please email Rose Palmer (rose.palmer@ucl.ac.uk) with details. Please also contact Rose if you have any suggestions for articles or comments about the newsletter.

For more information please see: http://www.iapt.nhs.uk/cyp-iapt

10