Major Competency:Management

April 2013 ST C&ANorth West Deanery

April/May 2013

1 – Introduction [self, team, department, multi agency]

2 - Finance

3 – Commissioning

4 – Workshop

5-8 (preparation) – Timmorri@liverpool.ac.uk

9/10- Presentation

Personal introduction

• Current placement

• Management courses/experience

• Strengths & weaknesses

• Why attending this course?

Whatever happens?• Massive turmoil

• Adaptation and innovation

• Need the right number of staff with the right skills in the right place at the right time for the right price!

• Winners and Losers

Major Competency

• Managing a budget

• Managing Risk

• Handling complaints

• Involving service users

• Evidenced based practice

• Applying good practice standards

• Monitoring and analysing outcomes

• Audit

• Influencing organisations

Managing Yourself

• How is your desk & office organised?

• What clinical and administrative tasks do you delegate? e.g. booking appointments, messages, notes & filing.

• How do you organise your diary & tasks – paper or computer?

• How easy am I to work with (this is not only about being nice)

Managing Yourself

Exercises

• Review weekly job plan & log of activity for one week

• How much do I cost to employ?

• 360 appraisal – exercise or utility

• Preparation for next session – will you? Action orientation or words?

Core Clinical Skills for C&A Psychiatrists

• Identification and treatment of psychosis, severe depressive illness, organic mental states, severe somatoform disorders

• Psychopharmacology

• Advice in respect of high risk of self-harm, suicide and harm to others

• Advice on treatment of severe, complex ADHD, OCD and TICS

• Advice on and management of Eating disorders

• Identification of, formulation of, and advice in, complex cases e.g child protection, LAC, Youth offending

• Certain types of paediatric liaison work

• Assessment of complex or atypical ASD

Competencies of a C&A Team

Is there clarity?

• What we do

• What we could do

• What we should do

• What we are asked to do

• How we do it together

Clinical Competencies of a Team

• Initial formulation and diagnosis of most cases

• Risk assessment of self-harm and harm to others

• Formulation and management of most cases of self-harm

• Initial ADHD assessment and treatment of cases not needing medication

• Family therapy clinics

• Parent management skills

• Cognitive-behavioural therapy

Potential Risks at Team Level

• The model is not owned by everyone in teams and services

• No appropriate skill mix in teams

• Too many interfaces

• Isolation, confusion of roles

• Lose good practice, especially working together in patch teams

• If one is the only specialist in that area what happen when they are off?

MDT

• “One obstacle to the smooth running of multidisciplinary teams is the desire of doctors to be in charge.” Cottrell 1993

Departmental Organisation

• What are the structures & processes?

• Who is in the department?

• Who decides what, and where?

• What are the lines of management – personnel/clinical?

• What are the management/departmental meetings – who attends and what is decided?

• What arrangements are there for appraisal?

Departmental Organisation

Exercises

• Review departmental structure and personnel [3 mins ]

• Review structure & purpose of departmental meetings [3 mins]

• Describe 3 potential improvements

Leadership & Teamworking

• Who sets goals & how are these evaluated?

• How is activity information used?

• Is there a service description & priorities?

• Is there a regular development day? How is this organised & evaluated?

• How are new developments planned & agreed?

• How is expertise recognised?

Communication & Meetings

• What is the remit?

• Who attends – and how is this decided?

• What is the agenda?

• Are minutes kept and distributed?

• Focussing on what has to be decided, and what actions are agreed

• How are decisions and actions implemented and reviewed?

• How to deal with non-attenders, or people who talk too much or too little?

Clinical Governance

• What are the structures & processes for clinical governance?

• How does CAMHS relate to these?

• How is audit organised?

• What protocols are in place and how are these reviewed?

• What audits have been completed?

• How are clinical incidents reported and reviewed?

Conflict & Negotiation

• How to manage people who moan (problems)?

• How is efficiency & effectiveness monitored?

• What about punctuality and absence?

• What are the disciplinary processes?

• Difficult people e.g. non-participation, critical/hostile

Service Development

• What are the departmental processes for generating & developing the service?

• How are these negotiated within the trust/CCG and with other agencies?

• What funds are available for development?

• What are the national trends & drivers for development priorities?

Managing Change

• How is change planned & implemented?

• Is change negotiated or imposed?

• How are team members involved or informed?

• How do people react?

Working in CAMHS

“I’m all for progress, it’s change I can’t cope with”

Mark Twain

External context

• Which trust & directorate? CCG?

• CD, MD, CEO, Ch, board: who & how?

• When & where? Who represents you?

• Multiagency CAMHS planning? Who, when & where?

• Health England impact on CAMHS

Fragmented funding, multiple assessments and gatekeepers

Conductdisorder

Statement of SEN

Children in need

At risk register

ASSET APIR

£3billion

Social Worker

Youthoffending

team

Childpsycho-logist

Edwelfareofficer

Connex-ionsPA

SENCO & Ed Psycho-

logist

LEA special educational

needs

Connex-ions

EWSCAHMSYOTSocial Services

Youthworkers

Youth Service

£300million

£300million

£100million

£350million

£500million

£1billion

= assessment

= worker

= agency

Healthvisitor

ccg

Risks toparents

£?million

Children’sFund

£150million

The overall goal of comprehensive child and adolescent mental health services should be that of delivering seamless multi-sectoral mental health services for children, adolescents, young people and their families. The services must be effective, sensitive and appropriate to the needs of the local population, and based on achieving the best from partnerships in care.

TOGETHER WE STAND, HAS, 1995

GPs, Paediatricians, Teachers, School Nurses, Youth Justice Workers, Health Visitors, Social Workers, Voluntary Agencies etc

Tier 1

Individual Professionals Trainedin Children and Young People’s Mental Healthe.g. Psychiatrists, Psychologists, Therapists etc

Specialist Multi-disciplinary Teams

Tier 2

Tier 3

Very specialist

services, incl. children away from home Tier 4

The 4-tier model for CAMHS

Primary M

ental Health W

orkers etc

Health Advisory Service, 1995. Together We Stand

National Service Framework for National Service Framework for Children, Young People and Maternity Children, Young People and Maternity

ServicesServices

NSF Standard 9:The Mental Health and Psychological Well-being

of Children and Young People

“All children and young people, from birth to their eighteenth birthday, who have mental health problems and disorders have access to timely, integrated, high quality multidisciplinary mental health services to ensure effective assessment, treatment and support, for them, and their families.”

NSF Standard 9:

The Mental Health and Psychological Well-being

of Children and Young People

Universal

Targeted

Specialist

Every Child Matter

• Services are shaped by their histories and organised for the convenience of the provider not the client (Cabinet Office, 2001).

• Audit Commission report (2002): a general consensus that agencies need to work more closely together to meet the needs of young people, but different spending priorities, boundaries and cultures make this difficult to achieve in practice

• Interagency working of such services tend to 'underlap' rather than overlap and agencies can ignore the complexity their clients present

Multi-agency work

Barriers

Professional barriers – different professional cultures leading to different perceptions of role and priority and disagreement about assessment and intervention with young person

Communication barriers - often different professions and different organisations approach the same issue from a different perspective and use different terms;

Organisational barriers - different organisations may have different goals, priorities and structures;

Resource barriers - there may not always be sufficient money or time to support joint working.

Another Place Anthony Gormley

So what are users saying they So what are users saying they want?want?

• What children, young people and their families and carers want is often quite simple.

• They want consistent relationships with people who can help and to be treated with dignity and respect.

CAMHS Review 2008

Features of effective services – as defined by Features of effective services – as defined by children, youngchildren, young

people and their parents and carerspeople and their parents and carers

• Awareness• Of mental health and how to deal with it

• Trust• Build a trusting relationship• Regular contact with the same staff

• Clarity over confidentiality arrangements

Features of effective servicesFeatures of effective services

• Accessibility• Convenience• Accessible information and advice available

• Single point of entry to specialist mental health services

• Age-appropriate services

• Communication• Being listened to, given individual attention

• Straightforward, no technical jargon

• Involvement• Being valued

• Opportunity to discuss what services and interventions are available

• Support when it’s needed• Available when the need first arises, not when things

reach crisis point

• Support and follow up

Features of effective servicesFeatures of effective services

• Holistic approach• services that think about you as an individual; for example,

providing help with practical issues and addressing your physical health as well as your mental health

Summary of key findings from Focus groups and interviews with children, young people, parents and carers, conducted specifically for the Independent CAMHS Review Expert Group.

Features of effective servicesFeatures of effective services

Some Levers for Change

• Users and carers [Families]

• NSF Change for Children - Every Child Matters

• Comprehensive CAMHS

• Workforce challenge

• NHS Modernisation

• Commissioner-driven through contracting, contestability and service redesign

• Performance indicators• Activity data• Waiting times

“All models are wrong but some are useful”

W Demming

How to develop a service?

• Developing new roles, to bring new people into the mental health workforce

• Developing the roles of existing staff, to enable them to take on more or different tasks

• Ensuring that the skills of all staff are being used in the most efficient and effective way

Key lessons and actions

• No single blueprint for CAMHS

• Small changes can be easy wins

• Change one role and change all

• Leadership to support change is essential both from clinicians and managers

• There is more shared in common that distinct between professions [ Ten Essential Shared Capabilities]

• Will involve cultural change

Solutions [AIMS]

• Child & Family input into service design

• Clarity about realistic roles

• Recognise finite capacity and capabilities and avoid wishing unrealistic demands upon them

• Vertical and horizontal integration of services

• Clarify corporate responses

Solutions [ACTIONS]

• Use explicit plans and protocols for demand management

• Re-organise services to respond to need not diagnostic labels

• Consider information needs of all stakeholders

• Recognise concept of burden and impact

• Complexity means multiple respondents may be needed

• Matching between wants, needs, evidence of effectiveness and availability of expertise

• Supportive information systems

There are no well worn paths….

…. People and services wil l need

to move out of their comfort

zones.

Preparing For AConsultant Post

• What kind of post are you looking for?

• What posts are currently available in the North West?

• Ways to appraise a vacant post