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Rockingham 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: 1 August 2017

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Contents

1. Executive Summary 4

2. Community CAMHS 5

2.1 Rockingham Community CAMHS 6

2.2 Rockingham catchment overview 6

2.3 Staff 7

2.4 Capacity and demand modelling 7

2.5 Integration and shared care arrangements 8

2.6 Appointment scheduling 11

3. Budget 12

4. Referral Sources 13

5. Activity 14

5.1 Referrals 14

5.2 Access 15

5.3 Activations and Deactivations 21

5.4 Service Contacts (Occasions of Service) 23

5.5 Access by Aboriginal children and young people 24

5.6 Number of treatment sessions per episode of care 27

6 Safety and Quality 29

6.1 Documentation Audit Results 29

6.2 Internal Audit Results 30

6.3 Clinical Incidents 31

6.4 Risks 31

6.5 Quality Improvements 31

7 Education and Training of staff 33

7.1 Mandatory Training 33

8 Consumer and carer experience 34

8.1 Experience of Service Questionnaire (ESQ) 34

8.2 Complaints and Compliments 36

9 Patient Outcomes 37

9.1 NOCCS 37

10 Policy 38

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1. Executive Summary Rockingham Community CAMHS provide services to the Rockingham catchment area for infants, children and young people, up to their 18th birthday with severe and/or complex emotional and mental health wellbeing concerns. The service serves an estimated population of approximately 42 733 zero to 17 year olds with 12.4 FTE (Full Time Equivalent) staff. The multidisciplinary team is comprised of a number of clinical disciplines led by a Consultant Child and Adolescent Psychiatrist and Service Manager. The team operates to an approximate budget of $1.9 million per annum.

Rockingham Community CAMHS has a number of key partnerships with other services in the local area, both internally and externally. Rockingham CAMHS recently initiated a project focused on building their relationship with local schools in the areas, which will include monthly meetings with seven secondary schools in the area where there is high demand for CAMHS services. Rockingham CAMHS has also developed very strong relationships with local GP’s and provides a GP consultation service for practitioners who are considering referring a young person to CAMHS, or who have concerns about a young person who is under their care.

In the last financial year, Rockingham CAMHS received an average of 50 referrals each month. The referrals were most commonly from external medical practitioners. Their median wait time from referral to a Routine Choice appointment was 27.5 days and that from referral to Partnership (treatment) was 39 days. They activated 11 new clients per month on average and deactivated approximately the same number. The median number of treatment sessions per episode of care was 8, and the Interquartile range (IQR) 10.5 sessions.

Rockingham 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. Two clinical incidents were reported at Rockingham during this period, which were thoroughly investigated with appropriate actions taken by Rockingham CAMHS to prevent similar incidents from occurring in the future. The Rockingham CAMHS team maintains its level of compliance with mandatory training above the level expected of Community CAMHS teams. The team also took part in clinical outcome measures training in October 2016.

Rockingham CAMHS actively seeks consumer feedback via an Experience of Service Questionnaire (ESQ). In the last financial year 122 children and adolescents and 187 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 Rockingham CAMHS waiting area. In this period, Rockingham CAMHS received no formal compliments and three formal complaints. These complaints were investigated and responded to promptly.

Rockingham CAMHS regularly review and implement service wide policies and guidelines to ensure overall compliance to policy.

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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 wellbeing 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; and

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; and

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; and

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

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2.1 Rockingham Community CAMHS

Rockingham Community CAMHS was established in 2005. It is located at the corner of Ameer St and Clifton St, Rockingham.

2.2 Rockingham catchment overview

The total estimated population in the Rockingham Catchment in 2015 was 165 927 based on projections from the Australian Bureau of Statistics (ABS) data. Of the total population, 42 733 were aged between 0 – 17 years old. The estimated 0-19 year old Aboriginal population in the Rockingham catchment in 2013 was 1 693 (data based on ABS data and planning data by the CAHS Epidemiology team).

Total population, population by age

Rockingham Community CAMHS

Total Population Population of 0 - 17 year olds

Population of Aboriginal 0 - 19 year olds

165 927 42 733 1 693

Map of Rockingham catchment

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2.3 Staff

Rockingham Community CAMHS is comprised of a multidisciplinary team with members from Child Psychiatry, Clinical Psychology, Nursing, Social Work, and an Aboriginal Mental Health worker. 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) in providing 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 Rockingham CAMHS is shown in the below table.

Staff and FTE, Rockingham CAMHS, June 2016

Rockingham CAMHS staff FTE Note

Salaried Medical Practitioners* 1.0 Consultant Psychiatrist/Head of Service

Clinical Nurse Specialist 1.0

Consultant Psychologist** 1.0

Psychologist 1.0

Senior Social Worker** 2.0

Choice Coordinator (Nursing)* 1.0

Child Protection Consultation Liaison 0.5 Agency Liaison Role so reduced clinical capacity

General Admin & Clerical* 2.4

Service Manager* 1.0

Suicide Response Initiative Position*** 0.6

Agency Liaison Role so reduced clinical capacity

Aboriginal Liaison Officer 0.5

Employed for six months within reporting period

CAMHS Education Liaison Teacher* 0.4

TOTAL Service FTE 12.4

TOTAL Case Management FTE

6.6

*These positions do not Case Manage clients and do not offer therapy. **FTE is split across more than one person (e.g. 1 FTE is filled by 2 part-time staff) ***Temporary Funded Position

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

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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 Rockingham would mean a group of 1367 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 427 children in the Rockingham 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:

The Local Community. Rockingham CAMHS places significant emphasis on integrating with and understanding its local community. The service aims to remain responsive and understanding to the ever changing landscape of its community. A key component in the development and maintenance of this responsiveness is the stability of the Rockingham CAMHS workforce. Rockingham CAMHS prides itself in having many team members who live and work in the catchment area. The local knowledge and face-to-face relationships held by these staff members enhances service delivery and community integration beyond what is statistically recorded. Rockingham CAMHS has a community allotment that it uses for individual and group therapy as well as engagement with families, carers and significant others. It also builds its links in the community by regularly taking part in and hosting events for Mental Health week with community partners.

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. Rockingham CAMHS meets monthly with their local CDS clinic to discuss recent trends and individual cases. As Rockingham

Total population

Clinical FTE Clinical FTE per 100,000

Recommended FTE for Rockingham population

Rockingham CAMHS

165 927 9.0 5.42 23.22

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CAMHS is located on the same site as Rockingham CDS, informal discussion also occurs between the teams on a regular basis.

The Department for Child Protection and Family Support (CPFS) provides a range

of child safety and family support services to West Australian individuals, children and their families, from the Kimberley to the Great Southern regions of the State. Rockingham CAMHS meets monthly with their local CPFS service to discuss recent trends and individual cases. The Rockingham CAMHS team includes a Child Protection Consultation Liaison clinician, who plays an important role in maintaining the relationship between the two agencies.

Department of Education – In 2016 Rockingham CAMHS initiated a project aimed at

building their relationship with local schools in the area. An internal working group was established to lead this project. The working group has set up a program of monthly meetings with seven secondary schools in the area where there is high demand for CAMHS services. These meetings will provide an opportunity for Student Support leads, School Psychology staff and Rockingham CAMHS clinicians to discuss how CAMHS can support schools to manage high risk students, and to develop pathways and processes to enable effective liaison between CAMHS and schools, especially in the event of a student attending an emergency department (ED). The Rockingham CAMHS team also includes a CAMHS Education Liaison Teacher (CELT) who plays an important role in both the internal working group and in maintaining strong relationships between the Rockingham CAMHS and local schools.

Statewide Specialised Aboriginal Mental Health Service (SSAMHS) – During the reporting period, Rockingham CAMHS employed an 0.5FTE Aboriginal Liaison Officer for six months through the SSAMHS funding initiative. Rockingham CAMHS also undertook planning for recruitment of a full-time Aboriginal Liaison Officer to further improve access and engagement for Aboriginal young people and families.

CAMHS Acute, Specialised and Community Directorates – Rockingham CAMHS

has sound working relationships with all services within the Acute and Specialised CAMHS directorates and works closely with these teams to achieve the best possible outcomes for patients receiving shared care.

Rockingham General Hospital – Rockingham CAMHS meet regularly with the Peel

and Rockingham Kwinana (PARK) Mental Health Service, which provides both inpatient mental health services at the Rockingham General Hospital and community mental health services on the same site as Rockingham Community CAMHS. These meetings are also attended by the Rockingham Hospital ED Psychiatric Liaison Nurse (PLN). The group is currently working on improving communication pathways between mental health services and the ED. The group is also working on several co-training initiatives, including a program which will involve the ED PLN spending time at the Rockingham CAMHS clinic and the Rockingham CAMHS Choice Coordinator spending time in the Rockingham Hospital ED. Rockingham CAMHS also take part in the orientation program for all new registrars at Rockingham Hospital, to educate them about both the services provided by Rockingham CAMHS and the relationship between Rockingham CAMHS and Rockingham Hospital.

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General Practitioners (GPs) – Rockingham CAMHS provide a consultation liaison service to GPs in the local area, whereby GPs who are considering referring a young person to CAMHS or who have concerns about a young person who is under their care are invited to meet with a Rockingham CAMHS clinician to discuss the young person’s case. Rockingham CAMHS also conduct regular analyses of their referral data so that they can provide targeted training to GP’s who routinely make inappropriate referrals to Rockingham CAMHS.

Kwinana Rockingham Action for Today's Youth (KRAFTY) – Rockingham CAMHS

regularly attends meetings of the KRAFTY group, where a range of local community support service providers meet to share information, form partnerships and advocate providing optimum services for vulnerable communities.

Headspace - Rockingham CAMHS is located in close proximity to Rockingham

headspace and has developed a sound working relationship with the service, particularly through their membership of the Rockingham headspace consortium group. Following a spate of completed and attempted suicides in the Rockingham area in 2016, Rockingham headspace lead the development of a working group of local service providers who will work together to develop a Community Response plan around suicide. Rockingham CAMHS is a member of this working group, which will also link in with the WA Primary Health Alliance suicide prevention trial project.

Other organisations that Rockingham CAMHS has established ongoing partnerships

with include: o City of Rockingham, through participation in Community Organised Events. o headspace School Support, through involvement in the headspace School

Support intervention pathway. This pathway will see Rockingham CAMHS assist with the seamless transfer of information and development of post-intervention plans following suicides within the Rockingham catchment.

o GP Down South, through the Rockingham CAMHS GP liaison service. Rockingham CAMHS plans to enhance this service to further improve the provision of seamless pathways of care and robust information and outcome sharing.

o Youth Focus, through productive co-working arrangements that promote shared care and seamless transition of care for young people and families.

o School Psychology Services, through participation in the area School Psychology Network meeting and the Principles Regional meetings.

o WA Primary Health Alliance, through participation in the development and modelling of an innovative approach to regional planning, integration and stepped care in primary mental health care in the prevention of suicide. The model will use an evidenced-based, systemic approach to suicide prevention based on the European Alliance Against Depression intervention structure.

o Thinker in Residence Program, through participation in a “think tank” session based on the development of smart App’s for young people at risk of suicide.

o Various community representative organisations, through the development of relationship with leaders and Elders that reflect the diverse population that Rockingham CAMHS services.

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2.6 Appointment scheduling

The workload of clinical staff is managed by allocating resources to choice and partnership appointments. The allocation of choice and partnership appointments varies for different staff members depending on their role, i.e. some staff provide more choice appointments and others more partnership appointments. Overall more choice appointments are provided than partnership appointments, since not all children and families progress to partnership. The partnership appointment is the commencement of therapy for the child and family.

Rockingham CAMHS schedule approximately 40 urgent Choice Appointments, 131 routine Choice appointments and 12 psychiatric Choice Appointments per 13 week cycle.

Rockingham CAMHS schedule approximately 45 Routine Partnership Appointments each cycle when at full clinical capacity.

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

Type of expenses

Actual Full Year June 2016

Budget Full Year June 2016

Variation

Total Expenses 1,838,099 1,876,455 38,356

Total Employments Cost[1]

1,516,942 1,541,193 24,251

Total Other Goods & Services[2]

321,157 335,262 14,105

Note: Variance is favourable

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4. Referral Sources

Referral Source Number of Referrals Received

Percentage of Referrals Received

MEDICAL PRACTITIONER 303 51%

OTHER ORGANISATION 92 15%

SCHOOL 71 12%

HOSPITAL 59 10%

INTERNAL PROGRAM 33 6%

UNKNOWN 24 4%

FAMILY / FRIEND 10 2%

OTHER PROFESSIONAL 4 1%

SELF 2 <1%

EXTERNAL PROGRAM 1 <1%

Grand Total 599

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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.

Average – the average number of referrals received each month over the reported period (50).

Control Limits – control limits are set three standard deviations above and below the mean.

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5.2 Access

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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 was 27.5 days. Interquartile range (IQR) is 22.5 days.

On review and analysis of the thirteen outlying cases represented in the graph above, key similarities were identified. These included:

11 out of 13 cases either did not opt in or did not attend (DNA) their initial appointment ;

2 out of the 13 cases attended an initial Choice Appointment but required a second Choice Appointment which was re-booked at a later date;

3 of the 11 cases that required a second Choice Appointment following an initial DNA did not attend the second Choice Appointment (arranged by phone and mail confirmation).

8 out of the 11 cases that initially DNA’d attended a second Choice Appointment.

To promote engagement, flexibility of Choice Appointment times and dates was treated as a priority in engaging families that did not attend an initial appointment but were considered to be in need of assertive follow-up. As such, the dates represented in the above graph do not represent the availability of Choice Appointment offered by the Service; they represent the most convenient date and time for the client to prompt engagement.

The bottom graph is a control chart. This shows:

Access time (orange line) – represents wait times from referral to choice over time, each dip and spike represents an individual young person’s wait times.

Median – the median wait time from receipt of referral to choice over the reported period (27.5 days).


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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. Median wait time for Partnership is 39 days. Interquartile range (IQR) is 29.5 days.


Access time (orange line) – represents wait times from referral to choice over time, each dip and spike represents an individual young person’s wait times.

Median – the median wait time from receipt of referral to partnership over the reported period (39 days).


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The top graph is a box and whisker plot. Median wait time from Choice to Partnership is 13 days. Interquartile range (IQR) is 14.5 days.


Access time (orange line) – represents wait times from choice to partnership over time, each dip and spike represents an individual young person’s wait times.

Mean – the mean wait time from choice to partnership over the reported period (16 days).


Timely access to Partnership Appointments following the identification of a need for Tier 3 service involvement is an integral component of the Rockingham CAMHS service ethos. A median wait time of 13 days to a comprehensive assessment and therapeutic involvement has led to a reduction in Did Not Attends for Partnership Appointments, and the timely engagement of multiple wrap around services delivered through the case management model. The short period of time between identification of need and intervention improves outcomes for young people and families.

Anomalies are a result of non-engagement at Partnership and assertive outreach approaches around this.

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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 (11).

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.

Top 10 principal activation codes 2015/16 FY:

Principal Activation Diagnosis Case Count

Adjustment disorders 46

Generalised anxiety disorder 22

Mixed anxiety and depressive disorder 15

Moderate depressive episode 11

Post traumatic stress disorder 6

Other childhood emotional disorders 3

Other mixed disorders of conduct and emotions 3

Mild depressive episode 2

Moderate depressive episode, not specified as arising in the postnatal period 2

Unspecified nonorganic psychosis 2

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Deactivations – the total number of deactivations each month.

Mean – the mean number of deactivations each month over the reported period (9).



Top 10 principal deactivation codes 2015/16 FY:

Principal Deactivation Diagnosis Case Count

Adjustment disorders 31

Generalised anxiety disorder 14

Post traumatic stress disorder 10

Mixed anxiety and depressive disorder 9

Moderate depressive episode 9

NOT KNOWN IN PSOLIS 9

Other mixed disorders of conduct and emotions 5

Childhood emotional disorder, unspecified 2

Disturbance of activity and attention 2

Mild depressive episode 2

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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 (350).


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5.5 Access by Aboriginal children and young people

It is hoped that the full-time Aboriginal Liaison Officer that Rockingham now employs will enable the clinic to further develop a flexible and assertive outreach approach that will result in a significant increase in referrals to the service for Aboriginal young people and address the access issues for Aboriginal families in the catchment area.


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 (4).


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 (<1).



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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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 (13).


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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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 8. The Interquartile range (IQR) is 10.5 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 above graph identifies two outlying cases. Both of these cases had exceptional complex multifactorial needs at the time of intervention from the service. Extensive involvement on the grounds of risk and safety and multiple complex case meetings with external agencies occurred. One of these cases was discharged during this time period.

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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 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.

There was 1 documentation audit at Rockingham CAMHS between 1 July 2015 – 30 June 2016. This was undertaken in June 2016 and audit results are summarised in the table below. Rockingham will be re-audited in June and December 2017 to assess improvement.

Audit area Number of actions against areas of low compliance

Comments Actions completed (yes/no)

Documentation (19 criteria) Nil

Intake & Assessment (7 criteria)

Nil

Individual Management Plans (26 criteria)

Nil

Shared Care (3 criteria) Nil

Risk Assessment (10 criteria) Nil

Risk Management (5 criteria) 2 More details required regarding triggers and deescalating risks in the plans

Complete

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Evidence of collaborative completion required e.g. signature

Complete

Discharge Planning (19 criteria)

3 Risk Assessment and Management Plan on discharge requires improvement on completion

Signatures of Discharge Planning, evidence of engagement documented but not signed in some cases

Evidence of Individual Management Plans (Discharge) given to families and young people on discharge limited in documentation.

Complete

Complete

Complete

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 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. Princess Margaret Hospital have elected to undergo two interviews per month, CAMHS one per month, and CACH one every alternate month.

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

Rockingham CAMHS were assessed against the following action items: NSMHS 1.10, 1.15, 10.4.8,10.4.7 NSQHSS 1.17.2, 1.14.2, 2.9.1, 2.3.1, 5.5.2 Rockingham CAMHS was assessed as being 100% compliant with no recommendations/suggestions Further information regarding the standards can be found at the following links: https://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards/ http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-n-servst10

https://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards/

https://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards/

http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-n-servst10

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6.3 Clinical Incidents

Two clinical incidents occurred at Rockingham CAMHS in the reporting period. One of these incidents was a Severity Assessment Code (SAC) 3 and the other a SAC 1. The SAC 3 was thoroughly investigated and appropriate actions were taken by Rockingham CAMHS to prevent similar incidents from occurring in the future.

With respect to the SAC 1, a number of recommendations were identified relating to both Rockingham CAMHS and wider CAMHS practices:

Mental Health Act (MHA) Forms and Mental Health Transport Risk Assessment Form - It was recommended that referrer contact details be clearly identified on these forms. This recommendation was communicated to the CAMHS MHA Implementation Group and Office of the Chief Psychiatrist’s MHA Help Desk to inform the review of the MHA forms.

Communication between Emergency Departments and Community CAMHS, including escalation processes for decision making – It was recommended that Consultant-to-Consultant discussions occur across services at points of difference in critical decision-making periods. This recommendation will be considered as part of the review of the State Wide Risk Assessment and Management Policy.

Shared Care Arrangements with CAMHS – It was recommended that the importance of the CAMHS Shared Care Guidelines be highlighted and that all services ensure up-to-date knowledge and implementation of the guidelines. An internal audit was recommended and has been completed.

E mail Communication - It was recommended that face-to-face or telephone communication should be used to convey information on a deteriorating clinical situation as documented in the CAMHS Clinical Handover process. This recommendation is to be incorporated into the review of the State-wide Risk Assessment and Management policy.

6.4 Risks

There were no specific risks relating to Rockingham CAMHS recorded on the CAMHS Risk Register during the reporting period. 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.

6.5 Quality Improvements

During the period 1 July 2015 to 30 June 2016 Rockingham CAMHS undertook a range of activities aimed at improving the quality of service they provide to their consumers. These included:

Mental Health Day activities;

Plans to improve the appearance of the consumer waiting area;

Provision of late night family therapy clinics;

Introduction of flexible clinic times; and

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Community Garden/Allotment (affiliated with gardening groups).

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7 Education and Training of staff

7.1 Mandatory Training Mandatory Training completion statistics from iLearn as of 20/03/2017

Mandatory training name Employee count

Percentage not

complete

Percentage is complete

Narrative (where required)

CAHS induction 14 0% 100%

Aboriginal cultural awareness 14 7% 93%

Accountable and ethical decision making 14 7% 93%

Mandatory reporting of child sexual abuse 3 0% 100%

Record keeping awareness 14 0% 100%

Manual Tasks 14 36% 64% *

Hand hygiene 14 43% 57% *

Workplace aggression and violence 14 50% 50% *

Basic life support 14 43% 57% *

Aseptic technique 3 0% 100%

Clinical handover 10 50% 50% *

Human error and patient safety 10 70% 30% No longer mandatory for CAHS staff

Infection control principles 10 30% 70%

Medication Safety 3 67% 33% *

Patient and family centred care 10 60% 40% *

Emergency Management - Community 14 43% 57%

*

WA Mental health act 11 27% 73% *

* The service continues to prioritise mandatory training in the context of service delivery within an increasingly busy community clinic. Work force transience resulting from the provision of short term contracts also impacts on compliance rates. Operational plans that are currently in place to increase training compliance include:

Monthly Compliance Reports are shared with the team at Business Meetings;

Training compliance is addressed as part of quarterly individual performance appraisals;

Job plans are regularly reviewed to ensure that time is allocated for the completion of mandatory training; and

Two ‘closed clinic mandatory training days’ are scheduled each year.

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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 Rockingham. 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, 122 children and 187 parents provided feedback via the ESQ.

Rockingham Community CAMHS 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.

9 - 11 years 28

12- 18 years 94

Parent/Carer 187

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8.2 Complaints and Compliments In the reporting period, Rockingham Community CAMHS did not receive any formal compliments through the Princess Margaret Hospital Customer Liaison Service. In the reporting period, Rockingham Community CAMHS received the following formal complaints:

A parent complained because the Rockingham CAMHS clinician who had been caring for their child left the service at short notice. The parents believed that they had not received enough communication from the service about the staff member’s departure;

The grandfather of a young person who was being treated at Rockingham CAMHS complained about alleged misconduct from a staff member at Rockingham CAMHS; and

The same grandfather made multiple complaints regarding the outcome of a Family Law Court matter involving his grandson.

All of these complaints were analysed to determine whether any service process improvements could be implemented at Rockingham CAMHS to reduce the likelihood of similar complaints being received.

In relation to the first complaint, it was determined that the complaint did not present any opportunities for service improvement as Rockingham CAMHS had followed due processes. A letter was sent to the complainant in response to the concerns raised which summarised the decisions made and actions taken by Rockingham CAMHS.

In relation to the second complaint, CAMHS engaged an external independent consultant to investigate the misconduct claim and was unable to substantiate the allegation. This was explained to the complainant in a response letter.

CAMHS sought advice from Medication and Legal Support Services in relation to third complaint and based on this advice, the complainant was informed that he would need to direct his concerns to the Australian Health Practitioner Regulation Agency and Family Court. CAMHS made amendments to its Multi-Disciplinary Team (MDT) Review policy to emphasise the need to discuss and document any complex clinical situations (e.g. child protection, family court or legal matters) in MDT meetings.

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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. Rockingham Community CAMHS staff completed this new training on 17 October 2016

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10 Policy

New/reviewed policy documents are implemented at Rockingham CAMHS via: o Email to all team members; o Subsequent discussion at team business meetings; and o Completion of Document Awareness Notification Forms.

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 (inclusion of information sheet for children and

families) CAMHS Temporary Electronic Storage Of SSCDs and MHA forms

o Community CAMHS policy document: Community CAMHS Multidisciplinary Team Review Guidelines – updated to

include reference to shared care

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.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

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

© Department of Health 2017

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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