what we have learnt…recap and reflections
Post on 31-Dec-2015
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• Re-cap on what we have learnt during workshops• Barriers and challenges• Input from the BOND team• Reflections on the learning
• Commissioners – with a budget and an interest in supporting CYP emotional and mental health in order to improve their outcomes i.e. health, education, welfare, etc
• Providers of not-for-profit services for CYP which provides therapeutic or psychological interventions, and/or support to CYP with mental health problems
• CVSOs have an important role to play and often offer good access in local communities, to a broad range of services
• Commissioners need to be confident in the VCS• CYP mental health is often perceived as statutory
CAMHS’ business – demand for clinical services outstrips capcity
• Early intervention works and is cost effective• Schools increasingly engaging in commissioning –
and need to know about VCS services• Need a broad range of services to meet a broad range
of need
Mental health expertise
Service ‘tiers’ 1 4
Access
School Counselling
Activity
based
Mediation
Young Carers
D.V.
Drop in
Mental Health Services
• Funding • Competition vs partnership• Specialist vs generic• Statutory service domination of partnerships• Capacity to compete –process excludes smaller
organisations or less ‘networked’ VCSOs• New requirements e.g. PBR, outcome measures• Business planning on shifting sand– personnel,
policy, environment• Need for new business approaches – marketing, cost
benefit analysis, etc
• Ensuring services are ‘safe’ and high quality• Fully understanding the market• Developing services for the most difficult to reach
groups• Ensuring timely access to appropriate MH expertise
in the right part of the system• Identifying best value for money
• Identifying pupils with a mental health problem and getting help quickly
• Want to refer directly to CAMHS• Want information back from services about pupils so that
can help them in school setting• Knowing what works and the difference between
services• Services must show an impact on a pupils’ ability to learn
Opportunities for…
External Environment
-Market and competition-Commissioning and delivery system
-Policy and drivers-MH spectrum/definitions-Commissioning environment-Quality assurance
Information gathering & exchange
Identifying critical issues and barriers
Tier 4: Inpatient Care
Infrequent competition amongst larger MH provider trusts
Some variety of providers More frequent tendering + increasing competition (usually LAs, NHS)
Numerous providers + commissioners Large + small organisations More VCS Less clinical governance Smaller contracts Frequent tendering
Tier 3: Clinical/ medical care (diagnosis/ medication)
Tier 3/2 interface: Primary MH services LAC, YOS, other targeted CAMHS
Tier 2/1 interface: ‘Generic’ School + community based e.g. counselling + IAG services Related services e.g. drop-in, youth support, family support
Limited contestability Increasing levels of competiti
on
• Emotional wellbeing, mental health, mental disorders?
• Early intervention mental health services?• Types of interventions
• Settings/age groups
• TaMHS
• Evidence based practice?
Children at risk;
in need; Social Care
vulnerable
Children with emotional
and behavioural difficulties; Education
special needs
Children with mental illnesses;
psychiatric disorders Health
FlourishingModerate
mental health
LanguishingMental
disorder
From: Huppert Ch.12 in Huppert et al.
(Eds) The Science of Well-being
Number of symptoms or risk factors
Flourishing Moderate mental health Languishing
Mental disorder
From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being
Number of symptoms or risk factors
Category
Types of work included
1. Social and emotional skills development of pupils
Social and Emotional Aspects of Learning (SEAL) programmes, Nurture groups and Circle time
2. Creative and physical activity for pupils
drama, music, art, yoga, outward bound activities
3. Information for pupils advice lines, leaflets, texting services, internet based information
4. Peer support for pupils buddy schemes, peer mentoring 5. Behaviour for learning and structural support for pupils
behaviour support, behaviour management, celebrating success, lunchtime clubs, calm rooms
6. Individual therapy for pupils counselling, cognitive and/or behavioural therapy7. Group therapy for pupils interpersonal group therapy, cognitive and/or behavioural therapy
groups 8. Information for parents leaflets, advice lines, texting services, internet based information
9. Training for parents parenting programmes such as Webster Stratton and Triple P programmes
10. Counselling/ support for parents
individual work for parents, family therapy, family SEAL – can include children and parents or just parents, or a combination
11. Training for staff specific training from a mental health professional 12. Supervision and consultation for staff
on-going supervision or advice from a mental health professional
13. Counselling/ support for staff provision to help staff deal with stress and emotional difficulties
Types of mental health work in schools (from TaMHS national evaluation 2012)
Level of evidence Type of evidence1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with
a very low risk of bias1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with
a low risk of bias1– Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of
bias*2++High-quality systematic reviews of case–control or cohort studies
High-quality case–control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal
2+ Well-conducted case–control or cohort studies with a low risk ofconfounding, bias or chance and a moderate probability that therelationship is causal
2– Case–control or cohort studies with a high risk of confounding bias, orchance and a significant risk that the relationship is not causal*
3 Non-analytic studies (for example, case reports, case series)4 Expert opinion, formal consensus*Studies with a level of evidence ‘–‘ should not be used as a basis for making arecommendation
• Commissioning (what’s involved? Where does procurement fit in? CYP participation?)
• Outcomes? Value for money?
Identify needs
Outcomes?
Plan and design pattern of services
Look to the market - Does it provide what
we need?Tender & Procure
Disinvest?Develop market?
how well is the service delivering
outcomes?
What have we learnt
about needs?
Resources? Priorities?
Strategic process for allocating resources
Weak Commissioning
Historically and provider led
Little effective challenge
Adequate Commissioning (status quo)
Good control over existing contracts
Narrow approach to commissioning around procurement and purchasing
Effective Commissioning
Commissioners engaging with communities on the pattern of services required
Commissioners shaping structure of delivery
Active redesign of services
Personalisation
Decommissioning
Intelligent Commissioning
Maximise value from total local public sector budget
Outcome driven
Empowering users and local communities
Widespread embracing of behavioural change
Some community led commissioning
Semi-autonomous personalisation
Driven by customer experience
Aiming to be here….
Many organisations operate here
REACTIVE COMMISSIONING
• Volunteer capacity (how cost effective is this?)
• Organisationally held knowledge and expertise
• Non-profit making – will this demonstrably make it cheaper than the competitor’s?
• Local brand (how strong is your brand? What is the perception locally?)
• Accessibility and less stigma - how do you demonstrate the benefit?
• Attract other funding – have you promoted your track record?
Twelve compulsory components must all be evidenced to demonstrate the provider is “commissionable”.
These are spread across:
• Accountability• Compliance• Empowerment
... with an opportunity to shine through evidence of added Values
The ACE–Value Commissioning Ready Framework
• Increased access to psychological therapies (IAPT)• Payment by Results• DfE – devolved decision making – pupil premium • Funding environment for VCS• Health reforms…
NHS
NHS Commissioning
Board
Monitor (economic regulator)
Clinical Commissioning Group
Department of Health
CQC (quality)
Providers
Public Health
England
(Local health improvement
in LAs)
Local authorities (via health & wellbeing boards)
HealthWatch
Local HealthWatch
• The only constant characteristic is change• Competition is increasing • Have to look outside usual funding sources• Some providers are joining together in order to try
and strengthen position of VCS• Relationships are highly valued and building trust
and reputation remains important• Communication from and between services and
schools is part of quality provision
Opportunities for…
External Environment
-Market and competition-Commissioning and delivery system
-Policy and drivers-MH spectrum/definitions-Commissioning environment-Quality assurance
Information gathering & exchange
Identifying critical issues and barriers
Internal Environment
VCSOs… where are you in this?
• Marketing•Cost effectiveness•VfM•Outcomes
• In ‘discipline’ groups• As a result of the workshop programme;
- what have you been prompted to think about
- changes you have in mind to make
- any action you have taken already• Prompts on sheets to help• Discuss and record main points
Opportunities for…
External Environment
-Market and competition-Commissioning and delivery system
-Policy and drivers-MH spectrum/definitions-Commissioning environment-Quality assurance
Information gathering & exchange
Identifying critical issues and barriers
Internal Environment
VCSOs… where are you in this?
• Marketing•Cost effectiveness•VfM•Outcomes
What does this mean for our…
Rev
iew
Ch
ang
e m
ana
gem
ent
Organisational Plan
Based on strategic plan
Local external environment
• Participate• Influence• Challenge• Find out
Needs & priorities?
Partnership?Competition?
Opportunities?
Based on Bryson, J. 1988
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