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Peel Community CAMHS

Safety, Quality, Performance, Patient Experience and Patient Outcomes Report

1 July 2015 – 30 June 2016

CAMHS Senior Project Officer

Child and Adolescent Mental Health Service (CAMHS)

© Child and Adolescent Mental Health Services, Child and Adolescent Health Services, Department of Health 2016

Version: 1.0

Last Updated: June 2017

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Contents 1. Executive Summary 2

2. Community CAMHS 3

2.1 Peel Community CAMHS 4

2.2 Peel catchment overview 4

2.3 Staff 4

2.4 Capacity and demand modelling 5

2.5 Integration and shared care arrangements 5

2.6 Appointment scheduling 7

3. Budget 9

4. Referral Sources 10

5. Activity 11

5.1 Referrals 10

5.2 Access 11

5.3 Activations and Deactivations 15

5.4 Service Contacts (Occasions of Service) 17

5.5 Access by Aboriginal children and young people 18

5.6 Number of treatment sessions per episode of care 21

6. Safety and Quality 23

6.1 Documentation Audit Results 23

6.2 Internal Audit Results 24

6.3 Clinical Incidents 25

6.4 Risks 25

6.5 Quality Improvements 26

7. Education and Training of staff 27

7.1 Mandatory Training 27

7.2 Other training completed by Peel Community CAMHS 28

8. Consumer and carer experience 29

8.1 Experience of Service Questionnaire (ESQ) 29

8.2 Complaints and Compliments 30

8.3 Consumer and carer involvement 30

9. Patient Outcomes 32

9.1 NOCCS 32

10. Policy 33

APPENDIX 1 34

APPENDIX 2 55

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1. Executive Summary Peel Community CAMHS provide services to the Peel catchment area for infants, children and young people, up to their 18th birthday with severe and/or complex emotional and mental health concerns. The service serves an estimated population of approximately 24,895 zero to 17 year olds with 11.9 FTE (Full Time Equivalent) staff. The multidisciplinary team is comprised of a number of clinical disciplines lead by a Consultant Child and Adolescent Psychiatrist and Service Manager. The team operates to an approximate budget of $1.9 million per annum.

Peel Community CAMHS has a number of key partnerships with other services in the local area, both internally and externally. Targeted funding through the Schools Suicide Response Program has enabled Peel CAMHS to develop particularly strong links with local schools, through the provision of in-reach for case management and delivery of school psychology and suicide prevention programs across the Peel region. Peel has also developed very strong relationships with local GP’s, including GP Down South. Peel CAMHS and GP Down South provide twice monthly collaborative practice in Waroona (a remote area of the Peel catchment), through the mobile GP Down South service

In the last financial year, Peel received an average of 35 referrals each month. The referrals were most commonly from external medical practitioners. Their median wait time from referral to a Routine Choice appointment was 17 days and that from referral to Partnership (treatment) was 26.5 days. They activated 10 new clients per month on average and deactivated approximately the same number. The median number of treatment sessions per episode of care was 12, and the Interquartile range (IQR) 17 sessions.

Peel CAMHS were assessed against National Safety and Quality Health Service Standards and all areas assessed were successfully met. An internal documentation audit conducted in the last financial year generated recommendations that have all been completed. One clinical incident was reported at Peel during this period, which was thoroughly investigated with appropriate actions taken by Peel CAMHS to prevent a similar incident from occurring in the future. The Peel team maintains its level of compliance with mandatory training above the level expected of Community CAMHS teams. Some team members have further extended their clinical skills by completing training in areas such as family therapy. The team also took part in clinical outcome measures training in August 2016.

Peel CAMHS actively seeks consumer feedback via an Experience of Service Questionnaire (ESQ). In the last financial year 153 children and adolescents and 175 parents/carers provided feedback via the ESQ. In response to the ESQ’s, feedback posters that describe the actions taken are regularly displayed in the Peel CAMHS waiting area. In this period, Peel received one formal complaint. This complaint was investigated and responded to promptly.

Peel CAMHS regularly review and implement service wide policies and guidelines to ensure overall compliance to policy. The Peel CAMHS Service Manager was an active member of the CAMHS Policy and Procedures Steering Group throughout the reporting period.

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2. Community CAMHS Community CAMHS provide services for infants, children and young people under 18 years of age who have severe and/or complex emotional and mental health concerns which are causing them to experience substantial impairment in functioning on a continuous or intermittent basis. Community CAMHS services are located throughout the Perth metropolitan area, staffed by multidisciplinary teams who offer evidence-based individual, family and group interventions.

In working together with children, young people, families and support networks, Community CAMHS supports them to become decision-makers in their own care, implementing the principles of recovery-oriented child and adolescent mental health practice. Recovery oriented practice supports and recognises the following:

The uniqueness of the individual

Real choices

Attitudes and rights

Dignity and respect

Partnership and communication

Key principles for service delivery:

Provides a holistic framework that informs all contact with children, young people and families

Builds and enhances strength, resilience and social well-being

Supports children to return to a normal developmental trajectory

Is underpinned by the premise that children and young people do recover from mental health problems

Engages with all areas of the child, young person and family’s life, including relationships, education, vocation and leisure

Informs the recovery plan that is regularly reviewed by the child or young person, family and multidisciplinary team.

Children and adolescents often present with complex, multifactorial problems. The reason for entry to CAMHS must relate to mental health problems, although other concurrent and/or associated difficulties may exist (e.g. autism, intellectual disability, child protection issues). The range of presenting problems usually considered on referral includes:

Persisting suicidal ideation and/or behaviour

Severe risk-taking behaviour (including self-harm)

Psychotic symptoms

Depressed, sad and/or agitated mood

Severe and persisting behavioural and conduct disturbance

Severe and persisting peer and/or family problems leading to significant emotional distress and/or behavioural problems

Persisting and severe school avoidance and/or phobia

Severe anxiety (e.g. phobias, post-traumatic stress disorder)

Severe obsessions and compulsive rituals

Eating and body image disturbances

Complex ADHD with co-morbid emotional / mental health concerns.

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2.1 Peel Community CAMHS

Peel Community CAMHS is located on the Peel Health Campus (PHC) site, at 110 Lakes Road, Mandurah.

2.2 Peel catchment overview

The total estimated population in the Peel Catchment in 2015 was 111 965 based on projections from the Australian Bureau of Statistics (ABS) data from the 2011 census. Of the total population, 24 895 were aged between 0 – 17 years old. The estimated 0-19 year old Aboriginal population in the Peel catchment in 2013 was 1 200 (data based on ABS data and planning data by the CAHS Epidemiology team).

Total population, population by age


Total Population Population of 0 - 17 year olds

Population of Aboriginal 0 - 19 year olds

111,965 24,895 1,200

2.3 Staff

Peel Community CAMHS is delivered by a multidisciplinary team with team members from Child Psychiatry, Clinical Psychology, Nursing, and Social Work and specialist aboriginal staff. The team is led by the Service manager and Head of Service and supported by Administration staff. The Service Manager manages the financial, physical and human resources and works in partnership with the Head of Service (the Child Psychiatrist), who provides the clinical governance, together ensuring the delivery of an integrated child and adolescent mental health service based on a community driven and consumer focused model of care. The FTE breakdown at Peel is shown in the below table.

Staff and FTE, Peel Community CAMHS, June 2016

Peel Community CAMHS staff FTE

Administration 2.4

Social work (clinical) 2.5

Nurse (clinical) 2.7

Clinical Psychology (clinical) 1.4

Service Manager 1.0

Head of Service (clinical) 1.0

CAMHS Education Liaison Teacher (CELT) (clinical)

0.4

Child Protection Consultation Liaison Worker (clinical)

0.5

TOTAL 11.9

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2.4 Capacity and demand modelling

The ratio of available clinical FTE per total population is used as a way of describing capacity of mental health services to adequately service a population. A ratio of 14 clinical FTE per 100,000 total populations has been used in Queensland as a goal which would create sufficient capacity for a child and adolescent mental health services to meet known demand for service for children with severe and complex mental health disorders.

Suggested capacity of specialist mental health services to meet demand It has been estimated that 3.2% of children and adolescents experience a severe mental health disorder in a

one year period, which for Peel would mean a group of 746 children and adolescents experiencing a severe mental health disorder in a one year period.

Specialist mental health services have previously met demands of 1% of the 0-17 year old population, converting to an estimate of 249 children in the Peel area.

Population and FTE actual staff ratios

2.5 Integration and shared care arrangements Children, young people and families are recognised as being part of a wider community and Community CAMHS are viewed as one element in a wider service network. Each Community CAMHS collaborates and develops partnerships within all areas of CAMHS (Community, Acute and Specialised) and externally with other service providers to facilitate coordinated and integrated services for children, young people and their families. Community CAMHS also provides consultation liaison with primary care partner agencies and all other key stakeholders.

Key partnerships:

Headspace is the National Youth Mental Health Foundation providing early

intervention mental health services to 12-25 year olds, along with assistance in promoting young peoples’ wellbeing. This covers four core areas: mental health, physical health, work and study support and alcohol and other drug services. Although there is no headspace service in the Mandurah area, Peel CAMHS attends fortnightly meetings with the Rockingham headspace service.

The Child Development Service (CDS) is part of the Child and Adolescent Health

Service, providing a range of support services for children, with or at risk of developmental difficulties, and their families. Peel CAMHS attends monthly meetings with their local CDS to discuss recent trends and individual cases. Peel CAMHS and CDS also hold a bi-monthly liaison clinic at which complex cases belonging to either CAMHS or CDS can be reviewed by a senior staff member from the other service.

Total population Clinical FTE Clinical FTE per 100,000

Recommended FTE for Peel population


111,965 8.6 7.7 15.7

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The Department for Child Protection and Family Support (CPFS) provides a range of child safety and family support services to Western Australian individuals, children and their families, from the Kimberley to the Great Southern regions of the State. Peel CAMHS meet monthly with their local CPFS to discuss recent trends and individual cases. Peel CAMHS also has a 0.5FTE Child Protection Consultation Liaison (CPCL) role which enables close communication between CAMHS and CPFS. Whilst the Strong Families initiative is no longer operating, Peel CAMHS’ previous participation in this group allowed the team to strengthen their relationship with their local CPFS Director. It also allowed Peel CAMHS to develop links with a number of other local agencies (such as the Disability Services Commission).

Department of Education (DoE) - Peel CAMHS has a very strong relationship with the DoE. In addition to having an 0.4 FTE CELT, Peel CAMHS also receives funding through the Schools Suicide Response Program (SSRP). These components enable Peel CAMHS to provide extensive in-reach to local schools for case management and to deliver school psychology and suicide prevention programs across the Peel region. Peel CAMHS also attends mental health presentations delivered to schools by the GP Down South Program (including two recent presentations by former AFL footballer Heath Black). A Peel CAMHS Senior Nurse also participates in the DoE Complex Case review board and contributes to management plans.

Statewide Specialised Aboriginal Mental Health Service (SSAMHS) – During the reporting period Peel CAMHS undertook planning to integrate an Aboriginal Liaison Officer into their service, through the SSAMHS funding initiative. This clinician commenced in November 2016.

CAMHS Acute and Specialised Directorates - Peel CAMHS has strong relationships

with all CAMHS Acute and Specialised Services. Peel CAMHS works particularly closely with the CAMHS Eating Disorders Program (EDP) and have a high number of shared-care cases with this service, due to the distance that young people from the Peel region have to travel to access support from the EDP.

Touchstone CAMHS - Touchstone CAMHS provides day and outpatient services for adolescents with persistent deliberate self-harm and suicidality. The day service component operates from the Bentley Hospital site. The outpatient, group-based therapeutic arm of the program is held in community settings to facilitate access to a specialist service for young people who are unable to access the day program at Bentley. It also provides a venue for ongoing support following completion of the day program. Previously, Touchstone groups were run in the Joondalup and Rockingham areas. Following a cluster of suicides in the Peel region in early 2016, a third group was set up in the Peel area. Peel CAMHS continues to work closely with the Touchstone service to provide responsive and effective care for high risk young people in the Peel region.

Local hospitals – Peel CAMHS has strong working relationships with both the Youth Inpatient Unit and Mother and Baby Unit at Fiona Stanley Hospital. Peel CAMHS also work closely with Rockingham General Hospital (RGH) and accept a high number of

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referrals from the RGH Emergency Department (ED). Referrals are also frequently received from the PHC ED and Peel CAMHS attend a monthly ‘ED and Mental Health Liaison meeting’ with PHC staff.

General Practitioners (GPs) - Peel CAMHS work closely with the Peel Youth Medical Service. Peel CAMHS also attend monthly meetings with the GP Down South Program, with Peel CAMHS acting in an advisory capacity for this group. Peel CAMHS recently joined the GP Down South bus for twice monthly collaborative practice in Waroona; a remote part of the catchment area. This partnership has allowed Peel CAMHS to maximise access to mental health services for school aged youth at risk by conducting Choice appointments in Waroona, as well as family support appointments. As part of this out-reach work in Waroona, Peel CAMHS clinicians have visited every GP in the Waroona area to inform them of the services available at CAMHS.

City of Mandurah – Peel CAMHS work closely with their local council on initiatives involving young people in the Peel region. For example, Peel CAMHS is a member of the Community Safety and Crime Prevention Committee, which focuses on social development, environmental design, and community action, connection, and involvement. This committee meets once every two months.

Juvenile Justice – Senior Clinicians from Peel CAMHS meet with their local juvenile justice team every six weeks. The purpose of this meeting is to discuss juvenile justice clients who have co-morbid mental health issues, with a view to offering recommendations with regard to further assessment and management.

Peel Adult Mental Health – The Peel Adult Mental Health is located on the same site as Peel CAMHS. Peel CAMHS work particularly closely with both the Early Intervention Psychosis team and the Perinatal Mental Health team, with cross-consultation occurring frequently between the Adult and CAMHS teams.

‘Police and Principals’ meeting - Peel CAMHS is an active member of the Police and Principals group, which is intended to bring together staff from the local Police department, CPFS, school psychology services and both private and public school Principals in the Peel area on a quarterly basis. The meeting is an opportunity to discuss common issues across all local services and jointly plan collaboration where appropriate. It is also an opportunity for services to share advancements and updates in their services that will affect young people in the Peel region. Meetings are hosted by schools on a rotational basis.

2.6 Appointment scheduling

The workload of clinical staff is managed by allocating resources to choice and partnership appointments. The balance between choice and partnership appointments varies for different staff members, i.e. some staff provide more choice appointments and others more partnership appointments. Overall more choice appointments are provided than partnership appointments,

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since not all children and families choose to receive or are offered partnership appointments. The partnership appointment is the commencement of therapy for the child and family.

Peel Community CAMHS schedule approximately 273 Choice Appointments per 13 week cycle and 174 Partnership Appointments each cycle.

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3. Budget Peel Community CAMHS budget for the financial year of 2015/2016

Type of expenses

Actual Full Year June 2016

Budget Full Year June 2016

Sub-Total

Total Expenses 1,547,180 1,910,344 363,164

Total Employments Cost[1]

1,489,118 1,868,831 379,713

Total Other Goods & Services[2]

57,967 41,513 -16,549

Negative variance / % is unfavourable Note 1:

Employment costs are under-budget by $379,713. Unfilled FTE was a consequence of the state government recruitment freeze.

Other Goods and Services shows a minor unfavourable variance is due to unbudgeted expenses mainly outsourced services such as language translation and interpretation services.

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4. Referral Sources

Breakdown of referral sources for Peel Community CAMHS from July 2015 – June 2016.

Referral Source Number of Referrals Received

Percentage of Referrals Received

FAMILY / FRIEND 38 8%

HOSPITAL 43 9%

INTERNAL PROGRAM 10 2%

MEDICAL PRACTITIONER 181 37%

OTHER ORGANISATION 103 21%

OTHER PROFESSIONAL 12 2%

SCHOOL 74 15%

SELF 12 2%

UNKNOWN 12 2%

Grand Total 485

Note: If a young person was re-referred to Peel CAMHS less than 30 days after first being referred to Peel CAMHS, the re-referral was excluded from the above calculation. This method ensures that multiple referrals are not counted for the same episode of care.

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5. Activity Notes about activity graphs:

All graphs reflecting referral numbers, activations, deactivations and occasions of service show a trend that is apparent across all Community CAMHS service, whereby activity is heavily influenced by school holiday periods (April, July, October, December/January).

Control Charts: Control charts have two general uses in the management and continuous improvement of a service The most common application is as a tool to monitor specific processes and functions to check for stability and control. A less common but potentially more powerful use is as an analysis tool. Data is plotted in time order. A control chart always has a central line for the average, an upper line for the upper control limit and a lower line for the lower control limit. These lines are determined from historical data. By comparing current data to these lines, you can draw conclusions about whether the process variation is consistent (in control) or is unpredictable (out of control, affected by special causes of variation). If your data points are within the upper and lower control limits they are in control, if they are above or below then they are out of control. Service Managers can use control charts to monitor the variation over a period of time for the number of days that each child and family waits for an appointment. Remarkable levels of variation and trend might indicate a change in the process or increase in referrals received.

Box and whisker plots: A box and whisker plot is used to display information about the range, the median and the quartiles. In descriptive statistics, the IQR, also called the midspread or middle 50%, is a measure of statistical dispersion, being equal to the difference between 75th and 25th percentiles, or between upper and lower quartiles. In the box and whisker plots, our middle 50% is represented by the two grey boxes.

Scatter Plots: Scatter plots are similar to line graphs in that they use horizontal and vertical axes to plot data points. However, they have a very specific purpose. Scatter plots show how much one variable is affected by another. The relationship between two variables is called their correlation. Scatter plots usually consist of a large body of data. The closer the data points come when plotted to making a straight line, the higher the correlation between the two variables, or the stronger the relationship. If the data points make a straight line going from the origin out to high x- and y-values, then the variables are said to have a positive correlation. If the line goes from a high-value on the y-axis down to a high-value on the x-axis, the variables have a negative correlation.

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5.1 Referrals

This control chart shows:

Referrals – the total number of referrals received each month.

Mean – the mean number of referrals received each month over the reported period (35).

UCL – the upper control limit is set three standard deviations above the mean.

LCL – the lower control limit is set three standard deviations below the mean.

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5.2 Access

The top graph is a box and whisker plot. The consumer specification line is set to 28 days in order to provide a visual representation of how soon most young people and their families expect to access our community services. This graph shows that the Median wait time for Choice is 17 days. Interquartile range (IQR) is 15 days.

The bottom graph is a control chart. This shows:

Access time (brown line) – represents wait times from referral to choice over time.

Median – the median wait time from receipt of referral to choice over the reported period (17 days).

Control limits – the upper control limit is set three standard deviations above the mean. The lower control limit is set three standard deviations below the mean.

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With respect to the young people who waited more than 28 days for a Choice appointment;

One was an Aboriginal young person who was difficult to engage;

Four required a Psychiatry Choice appointment;

One required his/her appointment to be rescheduled several times due to a family holiday, clinician illness, and the young person failing to attend the appointment;

One was on a family holiday and unable to attend any earlier;

One was only available to attend appointments on Mondays and also had an appointment cancelled due to the young person being ill; and

One requested a later appointment due to the father working FIFO and being unable to attend any earlier.

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The top graph is a box and whisker plot. The consumer specification line is set to 56 days in order to provide a visual representation of how soon most young people and their families expect to access our community services. Mean wait time for Partnership is 26.5 days. Interquartile range (IQR) is 27 days.

The bottom graph is a control chart. This shows:

Access time (blue line) – represents wait times from referral to choice over time.

Median – the median wait time from receipt of referral to partnership over the reported period (26.5 days).

Control limits – the upper control limit is set three standard deviations above the mean. The lower control limit is set three standard deviations below the mean.

With respect to the young people who waited more than 56 days for a partnership appointments, this was a result of:

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Waiting for a specific clinician (e.g. clinical psychologist or female clinician);

The family requesting an appointment when a parent returned from a FIFO job;

The family requesting an appointment after a family holiday overseas;

A hospital admission;

The family cancelling numerous partnerships for various reasons on the day; or

Difficulties engaging some Aboriginal young people and their families.

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5.3 Activations and Deactivations


Activations – the total number of activations each month.

Mean – the mean number of activations each month over the reported period (10).



Top 10 principal activation codes 2015/16 FY: Principal Admission Diagnosis Case Count

Adjustment disorders 24

Mixed anxiety and depressive disorder 20

Moderate depressive episode 13

Anxiety disorder, unspecified 12

Generalised anxiety disorder 9

Mental disorder, not otherwise specified 6

Mild depressive episode 6

Unspecified nonorganic psychosis 5

Acute stress reaction 4

Post traumatic stress disorder 4

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Deactivations – the total number of deactivations each month.

Mean – the mean number of deactivations each month over the reported period (11).



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5.4 Service Contacts (Occasions of Service)


OOS – the total number of occasions of service completed each month.

Mean – the mean number of occasions of service completed each month over the reported period (320).



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5.5 Access by Aboriginal children and young people


Referrals – the total number of referrals received for Aboriginal young people each month.

Mean – the mean number of referrals received for Aboriginal young people each month over the reported period (1.6).



Please note that if a young person is not identified in the Patient Administration System (PAS) as Aboriginal then we have no way of identifying them in our reports.

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Activations – the total number of Aboriginal young people activated each month.

Mean – the mean number of Aboriginal young people activated each month over the reported period (0.4).




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OOS – the total number of occasions of service completed for Aboriginal young people each month.

Mean – the mean number of occasions of service completed for Aboriginal young people activated each month over the reported period (9).




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5.6 Number of treatment sessions per episode of care

The above graph only includes a count of the following service event items:

Assessment

Assessment Baseline

Assessment Final

Assessment Initial

Assessment Mid-Treatment

Medication Review

Therapy

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The box and whisker plot shows that the median number of treatment sessions per episode of care is 12. The Interquartile range (IQR) is 17 sessions. The scatter plot shows length of stay in months on the y axis and number of treatment sessions per episode of care on the x axis. The median length of stay is 7.2 months.

Outliers on the above graph represent:

Young people with complex psychosocial circumstances;

Young people with complex psychiatric presentations;

Young people with complex psychiatric presentation in the context of intellectual disability;

Young people with chronic and enduring mental illness complicated by trauma, assault and/or complex psychosocial circumstances;

Young people with persistent school refusal;

Young people who were admitted to hospital during the course of their treatment at Peel CAMHS;

Young people who were difficult to engage with, sometimes requiring a change of case manager to increase engagement;

Cases with forensic components;

Young people who had been prescribed medications requiring long-term psychiatric review;

Case involving co-treatment with Clinical Psychology or Princess Margaret Hospital for specialist intervention;

Young people recovering from particular physical illnesses (e.g. spinal fracture);

Young people transferred to Tier 2 services for follow-up on discharge; and

Young people waitlisted for Tier 4 services but held by CAMHS to enable follow through on recommendations.

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6. Safety and Quality

6.1 Documentation Audit Results

Quality mental health care is dependent on good clinical documentation. Assessment and diagnosis requires detailed and subjective information, often obtained from many sources. Care may be provided by a team of multidisciplinary clinicians, often from different services, and frequently after hours or in emergency settings. Clinical information needs to be accurately communicated quickly and without confusion. Standardised forms are one way of ensuring common reporting standards and ease of use across services.

In 2012, representatives from across WA Health agreed to a set of standardised forms to be implemented across the State. The forms that resulted span the overarching processes that are completed as part of the mental health assessment process, from triage to discharge.

These forms are known as the Statewide Standardised Clinical Documentation (SSCD) suite. It is acknowledged that the forms were developed by New South Wales Health, and that the WA Government was granted permission to use the forms across public mental health services.

The purpose of the audit in April 2015 was to assess the degree of implementation and roll-out of SSCD documentation at various different mental health organisations throughout the state. The results helped to identify areas where implementation was yet to be completely rolled out. It was expected that some areas would be more advanced in their implementation than others. The data was used to provide the Office of Mental Health with a complete picture of baseline implementation of the SSCD.

A documentation audit was undertaken at Peel in May 2016. Peel audited 13 medical records.

Audit area Number of actions against areas of low compliance

Comments Actions completed (yes/no)

Medical record ‘basics’ (16 criteria)

2 Medical record documentation:- Use of standardised forms for documentation

1. Raise with team at business meeting and planning day. 2. Check 3 client files at each line management supervision

Yes

Yes

Intake and assessment (7 criteria)

2 Intake and Assessment:- Clinicians to complete all pages of initial assessment document, including Mental State Examination, formulation and plan. 1. Raise with team at business meeting and

Yes

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planning day.

Training update- National Outcomes and Casemix Collection (NOCC)

Individual Management Plan /Recovery Plan (26 criteria)

3 Individual Management Plans:- Use My CAMHS Action Individual Management Plans:- Develop a proforma for Psolis management plans for every client

Individual Management Plans:- Ensure plans are current (within last 3 months).

NOCCs at review at Multidisciplinary Team meeting

Yes

Yes

Yes

Shared Care (3 criteria) 0

Risk Assessment (10 criteria) 1 Risk Assessment and Management Plan to be completed at Choice, Partnership and prior to discharge as a minimum.

Yes

Risk Management (5 criteria) 0

Discharge Planning (19 criteria)

3 Discharge:- Choice summaries to include specific details about client and family expectations of goals at the end of treatment. 1. Highlight at middle choice meeting. 2. Check 3 client files at each line management supervision

Discharge:- SSCDs saved on Wdrive until able to save on PSOLIS. 1. Email team memo and link to folder on wdrive

Yes

Yes

Yes

6.2 Internal Audit Results

The CAHS Internal Audit (IA) Program assesses nominated areas throughout CAHS against the National Safety and Quality Health Service Standards (NSQHSS) and where relevant the

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National Standards for Mental Health Services (NSMHS). The audit aims to provide feedback on current progress, identify gaps, provide recommendations and highlight achievements.

Audit interviews take place during the 4th week of the month. PMH have elected to undergo two interviews per month, CAMHS one per month, and CACH one every alternate month.

There was 1 internal audit at Peel during this period covering both the National Standards for Mental Health Services (NSMHSS) and National Safety and Quality Healthcare (NSQHS) Standards

Peel were assessed against 8 action items. Action items assessed resulted in all actions being met.

6.3 Clinical Incidents

One clinical incident occurred at Peel CAMHS in the reporting period. This incident was a Severity Assessment Code 3 relating to failure/insufficient/incomplete monitoring. The young person involved in this incident did not engage in his/her Peel CAMHS Partnership appointment, choosing to leave the appointment after a very short period of time. The young person’s parents were not in attendance at the appointment. The following day the young person was taken to the Peel Health Campus Emergency Department by police after absconding from home following an argument. A number of factors were identified as having contributed to this incident:

The mother was not notified that the young person had failed to engage in the Partnership appointment;

A risk assessment was not conducted after the young person left the partnership appointment; and

An acting Case Manager was not allocated to the young person when his/her usual Case Manager went on leave the day after the Partnership appointment.

The Peel CAMHS Service Manager and Head of Service addressed the above issues with the clinicians involved in the young person’s care. The importance of comprehensive documentation of risk assessment and adherence to the ISOBAR handover process was emphasised.

6.4 Risks Two generic Community CAMHS risk were listed on the risk register during this period:

Failure of CAMHS community facilities meeting mental health standards which was activated in 2012. This risk was ranked as high during this period.

Inadequate and invariable access to Community CAMHS services. This risk was ranked as high during this period.

Treatment Action Plans (TAPS) were in place to mitigate the risks throughout the reporting period. During the reporting period there was one risk on the risk register that was specific to Peel CAMHS. This related to “A reduction in clinical services at Peel CAMHS coupled with

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potentially unsafe environment for consumers and staff”. The following controls were in place throughout the reporting period:

Bi-annual OSH audits of facilities, which identify risk issues and action plans to address these issues.

Investigation into the creation of separate entry into the CAMHS area.

Duress system, protocols and mobile duress alarms in place.

Strategic business case submitted for all CACH and CAMHS facilities.

Identification of suitable outreach areas.

6.5 Quality Improvements

During the period 1 July 2015 to 30 June 2016, Peel CAMHS implemented the following quality improvement initiatives:

Introduction of two half-day mandatory training sessions per year;

Introduction of a daily intake SBAR meeting;

Development of a Peel CAMHS consumer group;

Development of a documentation checklist for clinicians to ensure that completeness of documentation is maintained for all clients;

Introduction of a medication database that enables staff to ensure that all appropriate processes are being followed for young people on psychotropic medication;

Development of a data dashboard that provides detailed analysis of specific aspects of service (e.g. information on referrers, information on client’s postcodes etc.). Information obtained from this dashboard informs targeted work (e.g. out-reach to Waroona);

Waiting room renovations (based on negative feedback received from young people and families regarding the appearance and facilities in the waiting room);

Completion of a CAPA feedback survey to obtain families’ views on the CAPA process;

Introduction of a staff ‘Information Board’. This board acts as an information ‘hub’ for staff to view important details about service activity at Peel CAMHS. It is displayed in an area of high visibility for all team members and communicates a range of information about the service - from referral data to individual clinician activity. Information centres enable services to track their service demand and delivery and can be used to inform planning and development strategies. The Information Board is now being rolled-out across all Community CAMHS clinics; and

Restructure of monthly line management meetings between clinicians and the Peel CAMHS Head of Service/Service Manager.

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7. Education and Training of staff

7.1 Mandatory Training Mandatory Training completion statistics from iLearn as of 18 Jan 2017

Mandatory training name Employee count

Percentage not complete

Percentage is complete

Narrative (where required)

CAHS induction 13 23% 77% *

Aboriginal cultural awareness

13 8% 92% *

Accountable and ethical decision making

13 8% 92% *

Mandatory reporting of child sexual abuse

6 17% 83% *

Record keeping awareness 13 8% 92% *

Manual Tasks

13 46% 54%

* It has been difficult for

Peel CAMHS to access practical

manual training in the local area. CAMHS

has recently partnered with CACH to address

this issue by establishing regular, joint CACH/CAMHS

training sessions to be held at local

community clinics. -

Hand hygiene 13 54% 46% *

Workplace aggression and violence

13 69% 31% *

Basic life support

13 62% 39%

* It has been difficult for

Peel CAMHS to access practical CPR

training in the local area. CAMHS has

recently partnered with CACH to address this issue by establishing

regular, joint CACH/CAMHS

training sessions to be held at local

community clinics. -

Clinical handover 9 33% 67% *

Infection control principles 10 20% 80% *

28

Mandatory training name Employee count

Percentage not complete

Percentage is complete

Narrative (where required)

Medication Safety 6 83% 17% *

Patient and family centred care

9 78% 22% #

Aseptic technique 6 67% 33% *

* 4 new staff members commenced at Peel CAMHS between November and January and had not had a chance to

complete all mandatory training at the date the report was extracted. These 4 staff members represent a significant proportion of the Peel CAMHS workforce.

# The Patient and Family centred care training package is not considered to be as relevant to CAMHS as it is to other CAHS services. Within CAMHS, staff receive training in Recovery Orientated Care and Goal Planning which addresses the same key issues as the Patient and Family Centred Care training package in a format that is more relevant to mental health. Peel CAMHS completed this training as a team in October 2014.

7.2 Other training completed by Peel Community CAMHS Table 11: Other Training completed by Peel staff, as of 30 June 2016

CAMHS Orientation 2

Clinical Skills Training 2

AOD training through DAO 3

Introduction to Infant mental Health 1

Mentalization Based Treatment Skills (MBT Skills)

2

Mentalization Based Treatment for Adolescence (MBT-A) training

1

Eye-movement desensitisation and retraining 1

Circle of Security 1

Family Therapy 2

Authorised Mental Health Practitioner Training

2

In addition, due to the paucity of specialist mental services available in the Peel region and the difficulties associated with families having to travel to the city to access these services, the Peel CAMHS team has worked in collaboration with CAMHS Specialised services to develop their specialist mental health skills (e.g. for the treatment of eating disorders). This enables the Peel CAMHS team to deliver a range of specialist services in the local area.

29

8. Consumer and carer experience

8.1 Experience of Service Questionnaire (ESQ)

The use of the Experience of Service Questionnaire (ESQ), has enabled front line staff and the management team to better understand the way in which the service respond to the needs of children and families in Peel. Originally developed by the Commission for Health Improvement (CHI) in the UK and adapted for use in CAHS CAMHS, the Experience of Service Questionnaire (ESQ) is a 15-item self-completion questionnaire that assesses users’ views of services with respect to accessibility, humanity of care, organisation of care and environment. The ESQ can be completed by parents/carers, children and young people and is anonymous.

During the period 1 July 2015 – 30 June 2016, 153 children and 175 parents provided feedback via the ESQ.

Peel inform children, young people and their families of the changes made as a result of ESQ feedback via ‘You spoke, we listened’ posters, which are displayed throughout the clinic. An example of a recent ‘You spoke, we listened’ posters is included on the following page.

In response to ESQ feedback received during the reporting period, Peel CAMHS redesigned their waiting room. A TV was installed and seating was reconfigured to allow parents to be able to observe their children playing in the playroom, as per their feedback. The room was also repainted in a colour chosen by young people (paint samples were placed on the wall and young people were invited to vote on their favourites).

9 - 11 years 21

12- 18 years 132

Parent/Carer 175

Male (child) 66

Female (child) 87

ATSI via Parent 19

health.wa.gov.au

30

8.2 Complaints and Compliments There are no records of Peel Community CAMHS receiving any formal compliments in the reporting period. In the reporting period, Peel Community CAMHS received one formal complaint:

A parent wrote to the Minister querying the care provided to her daughter and access to mental health services in the Rockingham and Peel regions. The complaint was thoroughly investigated and it was concluded that CAMHS’ communication with the parent regarding her child had been timely and proactive. The child’s GP did not refer the family, or notify them of, Peel Community CAMHS and Acute Response Team services, which led the parent to wrongly conclude that a private referral, with a four-month waiting period, was the only option. As Peel Community CAMHS already had comprehensive practices in place to keep local general practices up-to-date of available services, it was concluded that no changes or improvements to Peel Community CAMHS services were required as a result of the complaint.

8.3 Consumer and carer involvement In November 2015 a review of all documentation used within Community CAMHS was initiated, including the welcome pack that is provided to children and families. Peel CAMHS volunteered to participate in the consultation. The purpose of consulting regarding the welcome pack was to ensure that we are providing children and families with the right information, in the right format and at the right time. The consultation included three different mechanisms for involvement: A waiting room activity; survey; verbal feedback between the family and their clinician.

The waiting room activity was included with the hope that it would generate feedback from younger children and other people that do not usually provide feedback.

Following the consultation a number of recommendations were made. The full consultation report has been included as Appendix 1, and the leaflet which was developed as a result of one of the recommendations from the report has been included as Appendix 2. Images of the consultation are included on the following page.

32

9. Patient Outcomes

9.1 NOCCS

NOCC, and in particular the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), may be used to fund episodes of care on a national level from the beginning of the 2017 financial year. NOCC training was identified as a gap in the training currently delivered face to face in Community CAMHS, as the online training package gave clinicians little opportunity to practice rating and no opportunity to discuss the clinical vignette with colleagues and managers. With the objective of training Community CAMHS clinicians in the clinical rating tools and embedding the scores into clinical management plans to improve services delivered to children, young people and their families/carers, a project was initiated to provide NOCC training and clinical utility training workshops to all CAMHS clinical staff that are responsible for completing NOCC measures. It was decided that special attention would be given to the HoNOSCA and ensuring that ratings given in this measure are reflected in clinical management and crisis management plans. Peel staff completed this new training as a team on 22 August 2016.

33

10. Policy

New/reviewed policy documents are implemented at Peel CAMHS via: o Email to all team members; and o Subsequent discussion weekly MDT meetings.

Recently released policy documents that have been discussed and implemented at team level include:

o Operational CAMHS policy document CAMHS Leave Backfill

o Clinical CAMHS policy documents: CAMHS Managing Clinical Risk After Disclosure of Child Sexual

Abuse CAMHS Sexual Safety Guideline CAMHS Shared Care Guideline CAMHS Temporary Electronic Storage Of SSCDs and MHA forms

Recently reviewed/updated policy documents that have been discussed and implemented at team level include:

o Clinical CAMHS policy documents: Admission to CAMHS inpatient unit procedure CAMHS clinical assessment policy CAMHS risk assessment and management policy

o Community CAMHS policy: Community CAMHS Multidisciplinary Team Review Guidelines –

updated to include reference to shared care The Peel CAMHS Service Manager was an active member of the CAMHS Policy and Procedures Steering Group throughout the reporting period.

https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/CAHS/CAMHS.PM.LeaveBackfill.pdf

https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/CAHS/CAMHS.PM.ManagingClinicalRiskAfterDisclosureofChildSexualAbuse.pdf

https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/CAHS/CAMHS.PM.ManagingClinicalRiskAfterDisclosureofChildSexualAbuse.pdf

https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/CAHS/CAMHS.PM.SexualSafety.pdf

https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/CAHS/CAMHS.PM.SharedCare.pdf

https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/CAHS/CAMHS.PM.TemporaryElectronicStorageOfSSCDsAndMHA%20forms.pdf

https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/CAHS/CAMHS.COMM.CommunityCAMHSMultidisciplinaryTeamReview.pdf

34

APPENDIX 1

Community CAMHS Welcome Pack Consultation Report

35

Child and Adolescent Mental Health Service © Department of Health 2016

Version: 1.0

Last Updated: March 2016

36

Contents

Background .............................................................................................................. 37

Review of Community CAMHS Welcome Pack ........................................................ 40

Survey ...................................................................................................................... 41

Prompt sheet for verbal consultation ........................................................................ 42

Waiting room activity ................................................................................................ 43

Results ..................................................................................................................... 45

37

Background

The Child and Adolescent Mental Health Service (CAMHS) provides mental health programs to infants, children and young people. This includes services set in the community and in a hospital setting. Child and Adolescent Mental Health Services are available for children and young people under the age of 18, and their families who are experiencing significant mental health issues.

There are 11 community CAMHS services across the Perth metropolitan area and ten of these services provide community assessment and treatment of persistent mental health difficulties in infants, children and young people. Children and families are referred to these services by their treating therapist, specialist, GP, school or other community organisation.

Historically Community CAMHS services had provided a range and variety of information to children and families when they accessed services. This included site specific leaflets and letters.

During 2011 – 2015, CAMHS Community Services underwent a service re-design and configuration which resulted in a consistent approach to treatment and care across all ten services. During the re-design, the need for a standardised information pack for children and families accessing the service was identified.

In addition, a number of reviews, standards and policy documents were guiding CAMHS to develop and/or provide key information to children and families:

Review of the admission or referral to and the discharge and transfer practices of public mental health facilities/services in Western Australia, Professor Bryant Stokes, 2012

3.3 The carers of patients need education, training and information about the ‘patient’s condition’ as well as what are the signs of relapse and triggers that may cause relapse.

3.5 The governance of the system should provide to carers, patients and GPs an appropriate way to navigate the mental health system in seeking advice and support, particularly in crises

4.3 Clinicians must ensure within their area of work that the service is totally patient- centred and that the patients and carers rights and responsibilities are understood and respected

7.10.14 Practitioners prescribing medications should ensure they comprehensively discuss compliance issues and discontinuation issues as well as any other relevant information associated with the particular medication prescribed.

National Safety and Quality Health Care Standards (2012)

38

1.17.2 Information on patient rights is provided and explained to patients and carers

4.13.1 The clinical workforce provides patients with patient specific medicine information, including medication treatment options, benefits and associated risks

4.15.1 Information on medicines is provided to patients and carers in a format that is understood and meaningful

4.13.1 The clinical workforce provides patients with patient specific medicine information, including medication treatment options, benefits and associated risks

9.9.2 Information about the system for family escalation of care is provided to patients, families and carers

National Standards for Mental Health Services (2010)

1.4 The MHS provides consumers and their carers with a written statement, together with a verbal explanation of their rights and responsibilities, in a way that is understandable to them as soon as possible after entering the MHS and at regular intervals throughout their care

1.16 The MHS upholds the rights of the consumer and their carer(s) to express compliments, complaints and grievances regarding their care and to have them addressed by the MHS

1.16 The MHS upholds the rights of the consumer and their carer(s) to express compliments, complaints and grievances regarding their care and to have them addressed by the MHS

3.2 The MHS upholds the rights of the consumer and their carer(s) to have their needs and feedback taken into account in the planning, delivery and evaluation of services.

6.9 Consumers are provided with current and accurate information on the care being delivered

10.2.3 The MHS makes provision for consumers to access acute services 24 hours per day by either providing the service itself or information about how to access such care from a 24/7 public mental health service or alternate mental health service.

10.5.3 The MHS is responsible for providing the consumer and their carer(s) with information on the range and implications of available therapies

10.5.7 The MHS actively promotes adherence to evidenced based treatments through negotiation and the provision of understandable information to the consumer

10.6.2 The consumer and their carer(s) are provided with understandable information on the range of relevant services and support available in the community.

39

Additionally, CAMHS are committed to ensuring we partner with children and families when we develop or review consumer and carer information. This commitment is underpinned by the National Safety and Quality Health Care Standards:

2.4.1 Consumers and/or carers provide feedback on patient information publications prepared by the health service organisation (for distribution to patients)

2.4.2 Action is taken to incorporate consumer and/or carers’ feedback into publications prepared by the health service organisation for distribution to patients

The standards and reviews provided CAMHS with a framework to guide the information required for a welcome pack and in partnership with children and families a first draft welcome pack was developed. The involvement of children and families included:

- A focus group at Rockingham Community CAMHS on March 27th 2014 - One to one meetings with a young person being treated for at Shenton

Community CAMHS

See appendix 1 for Draft Welcome Pack.

40

Review of Community CAMHS Welcome Pack

By July 2015, all Community CAMHS teams had transitioned to deliver treatment and care that was consistent with the Choice and Partnership Approach and in November 2016 a review of all documentation used within the service was initiated. This included clinical documentation; forms and the welcome pack.

The aim of consulting regarding the welcome pack was to ensure we are providing children and families the right information, in the right format and at the right time. The consultation included three different mechanisms for involvement: A waiting room activity; a survey; verbal feedback. The inclusion of the waiting room activity was included with the hope that it would generate feedback from younger children and other people that don’t usually provide feedback.

Welcome Pack Consultation Schedule:

Task Due Date Person Responsible

Planning December 2015 BR

Consultation 30 Jan – 15 March 2016 Rockingham and Peel Community CAMHS

Consultation Report complete

30 March 2016 BR

Community Document Review Team decide which recommendations to take forward

15 April 2016 NC and Review Team

Changes made and final documents and processes developed

30 April 2016

A number of Community CAMHS teams participated in the consultation.

Waiting Room Activity: Peel; Rockingham; Hillarys

Survey: Peel; Warwick; Shenton;

Verbally: Peel; Warwick; Shenton; Rockingham

41

Survey

42

Prompt sheet for verbal consultation

43

Waiting room activity

Peel and Rockingham Community CAMHS hosted an activity within their waiting areas. The activity attempted to ascertain when we should be providing information to children and families and in what format. It also asked which parts of the welcome pack were most important to children and families.

45

Results

Waiting Room Activity

From yourclinician

In thewaitingroom

Via email Via postOn theCAMHSWebsite

Do notwant to

receive thewelcome

pack

Number of people 0 2 2 4 1 4

0

1

2

3

4

5

Nu

mb

er

of

pe

op

le

Preferred method of receving Welcome Pack

46

CAHSCAMHS

Info forC&YP

CAMHS V& G

PrinciplesESQ Complaints R & R Contacts

Number of People 1 2 2 0 2 1 2

0

1

2

3

Nu

mb

er

of

Pe

op

le

Informationchildren and parents would like to receive in the welcome pack

At the GP Visit forReferral to CAMHS

Before the ChoiceAppointment

During the Choiceappointment

At partnership

Number of People 0 4 0 0

0

1

2

3

4

5

Nu

mb

er

of

Pe

op

le

Preffered time to recieve the welcome pack

47

Verbal feedback

Verbal feedback was collected by clinicians talking to children and families at the end

of their appointment:

Too much information and paperwork

“Overwhelming”

To childish (reference to the pamphlets) – from both parents and older children.

Information by post is the most preferred option

Of all the information the “what to expect” sheet was the most popular to receive, however not in conjunction with the others documents (see above comment re: to much paperwork)

Other comments

Would prefer the information at the point of referral e.g. at the GP surgery/school etc (they did not say what and how much though)

48

Feedback form results

Comments:

Very much so

Parents/Carers

Young PersonOther Family

MemberCAMHSClinician

OtherProfessional

Number of People 4 2 0 0 0

0

1

2

3

4

5

Nu

mb

er

of

Pe

op

le

Profile of Respondents

Do you think the brochure increased your knowledge about CAMHS?

Yes 6

No 0

Unsure 0

0

1

2

3

4

5

6

7

Axi

s Ti

tle

Usefulness

49

Comments:

Yes because when families are going through things and they need help sometimes it can be daunting and if you are well informed it helps make people more comfortable and understand what they are walking into

Some of it is useful

Comments:

All the information provided fitted well with me and I liked the guiding principles

Is the brochure a useful thing to receive before coming to CAMHS?

Yes 4

No 0

Unsure 1

0

1

2

3

4

5

Axi

s Ti

tle

Usefulness

Does the brochure meet any needs you may have about your culture?

Yes 2

No 2.4

Unsure 1

0

1

2

3

Nu

mb

er

of

Pe

op

le

Cultural Appropriateness

50

Comments:

The info is legible, clear, engaging and very informative

Mostly

Yes but its also a little daunting as there is so much information

Comments:

No it was very clear

After page 2 I became a little distracted and found I was skimming over it to get it finished

Is the information easy to read and understand?

Yes 4

No 0

Unsure 2

0

1

2

3

4

5

Nu

mb

er

of

Pe

op

le

Readability

Are there certain parts of the brochure that you found more difficult to readthan other parts?

Yes 1

No 5

Unsure 2

0

1

2

3

4

5

6

Nu

mb

er

of

Pe

op

le

Readability

51

Comments:

Experience of Service Questionnaire and making a complaint

Not really a lot of info.

ESQ

I think the guiding principles, ESQ, complaints and compliments, charter of rights and

responsibilities

Comments:

More details for Parents of to where to go for them to get support, and telephone help

lines sometimes are not what is needed

Is there anything included in the brochure that you would not need before yourfirst appointment?

Yes 2

No 1

Unsure 0

0

1

2

3

Nu

mb

er

of

Pe

op

le

Content

Is there any missing information that you would like to know?

Yes 1

No 2

Unsure 1

0

1

2

3

Nu

mb

er

of

Pe

op

le

Content

52

Comments:

A welcome pack could be placed on the table for parents of clients to read

Remove ESQ

Make it a tad less straight forward

I think by reducing the amount of info first given (pre-appointment_ and giving it during

the first few sessions may help people to actually take it all in

Comments:

Yes, colours make a difference

If you could change anything, what would it be?

Yes 0

No 0

Unsure 0

0

1

Nu

mb

er

of

Pe

op

le

Content

At first glace, did the brochure appeal to you?

Yes 4

No 1

Unsure 0

0

1

2

3

4

5

Nu

mb

er

of

Pe

op

le

Appeal and Presentation

53

Comments:

Comments:

Yes, easy to read, engaging, easy to understand

Did you want to pick it up and read it?

Yes 3

No 0

Unsure 2

0

1

2

3

4

Nu

mb

er

of

Pe

op

le


Was the format and design appealing to you?

Yes 4

No 1

Unsure 0

0

1

2

3

4

5

Nu

mb

er

of

Pe

op

le


54

Comments:

Very

Other Comments:

Wellbeing centre - change the language, change "CAMHS" terminology. Think

medication, mental asylum, looking after whole wellbeing. Interested in consumer group.

Recommendations

1. Consideration should be given to providing children and families with page one only of the Community Welcome Pack via post prior to their first appointment (About CAHS; About CAMHS)

2. Consideration should be given to including a link on the invitation to book letter, directing children and families to additional pages of the welcome pack.

3. Consideration should be given to provide information about Rights, How to complain, and the Experience of Service Questionnaire during the Choice Appointment.

4. Consideration should be given to children and families given a choice of mechanisms to how they receive the above (4) information. Ie. A paper copy or via email

5. Consideration should be given to including a mechanism for further feedback about the welcome pack, on the welcome pack. Feedback should be incorporated into a future revision of the welcome pack in 12 months’ time or when deemed necessary

Were the colours and graphics appealing to you?

Yes 4

No 1

Unsure 0

0

1

2

3

4

5

Nu

mb

er

of

Pe

op

le


55

APPENDIX 2

This document can be made available in alternative formats on request for a person with a disability.

© Department of Health 2016

Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.

http://www.health.wa.gov.au/

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