Mental health service transitions for young people
Performance management, monitoring and evaluation
Audit and performance management processes help improve the planning of care and support for young people in transition.(21)
Working with the University of Leeds, the Mental Health Foundation and young people themselves, the 'Market Place', a Youth Access Information Advice and Counselling service, has developed its own self evaluation tool, called 'How do you rate your life at the moment?' to measure progress in young people between the start and completion of a course of one to one support.
- Follow-up and monitor outcomes after discharge from CAMHS, including those young people who don't transfer to AMHS.
- Audit, review and evaluate your practice and service models and include young people, families and carers in the process.
National health policy and guidance from the DH and other central government departments emphasise the need for all services to monitor their performance, and a variety of outcomes frameworks and national-level indicators have been developed to support such activity. Throughout the cross-government mental health strategy, 'No health without mental health' (7) the importance attached to monitoring outcomes is a central theme. This is also reflected in the DHSSPS Service Framework for Mental Health and Wellbeing in Northern Ireland. (26)
Specifically in terms of young people in contact with mental health services, there are a number of assessment processes, planning systems and quality criteria that can be used to audit and evaluate service performance and staff practices. These include:
- the CAF and the Framework for the Assessment of Children in Need and their Families
- the CPA
- the 'You're welcome' quality criteria for young people friendly health services. (2)
- different assessment and planning approaches are used in Northern Ireland.
Things to consider
In developing audit and performance management processes to help improve the planning of care and support for young people in transition between or from mental health services, the learning from SCIE's research and the findings from the national CAMHS review (22) all provide valuable pointers.
- If they are not already in place, all services need to build and implement audit and review systems and routine monitoring indicators, and to provide training to staff in what data needs to be collected for monitoring purposes, in order to ensure that what is collected is robust and accurate. It is also important to consider service effectiveness, accessibility and acceptability.
- See the NHMDU SAT (gives principles for audit programme)
- The voice of young people, parents and carers must be fully factored into routine monitoring indicators. Third sector services often have expertise and the good practice literature about young people's participation and involvement in mental health services can help in the selection of suitable tools and approaches for seeking feedback from services users and encouraging their participation.
- Monitor young people's outcomes, including those who don't go to AMHS to capture whether needs and resources were matched and to evaluate all unmet need. The SCIE briefing shows that a major omission from transition protocols is ensuring continuity of care for young people not accepted by AMHS. There was little monitoring of outcomes for this group.
- See the NMHDU/NCSS self assessment tool (data systems adapted to produce specific transition reports, including monitoring outcomes for all YP with ongoing needs at point of transition)
- Use national-level indicators or targets where relevant and/or feasible – for example, managers could use Commissioning for Quality and Innovation (CQUIN) targets as a way of improving the planning and monitoring of young people's transitions. In a number of CAMHS, successfully engaging young people in AMHS forms the basis of a target for receiving CQUIN money, with this being used to provide staff training about young people's transitions, to track such transitions and analyse care pathways. Such data is then used to inform planning and improve transition processes.
In monitoring or auditing staff practice or service performance, it is also recommended that data is collected that:
- records unmet needs, including any planning processes in place to try and rectify service gaps or limitations (e.g. commissioner forums, local transition boards)
- considers contingency and/or crisis arrangements for those young people who may fall outside local protocols or working arrangements (e.g. those lacking a diagnosis; young people with dual diagnosis/co-morbidity; and young people placed in inpatient or residential provision, including out-of-area provision).
- In Oxfordshire and Buckinghamshire an audit tool was used in all CAMHS teams to collect data on transitions practice with a sample of young people identified in January 2011 by clinical team managers as needing transfer. The results have been presented to teams and a clinical governance group. Following this, an action plan has been developed with the input of all stakeholders, which will be implemented in teams. A repeat audit will be carried out in due course.
- In Coventry CAMHS improving the transition of young people is the subject of a CQUIN target. The monies allocated through the CQUIN have funded extra administrative time to track all 16-year-olds open to the specialist team and to provide some dedicated time to analyse the data concerning the pathways of young people from CAMHS and to facilitate their participation. CQUIN money has also allowed the trust to develop a transition training strategy.