HOW NOT TO PLAY PING PONG WITH YOUR CLIENTS

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HOW NOT TO PLAY PING PONG WITH YOUR CLIENTS

• Yvonne Gilles-Jones Clinical Nurse
  Specialist/Referrals Coordinator CAMHS Tier 3
• Jane Ware Consultant Clinical Psychologist CAMHS
  Tier 2 3
• Kent Medway NHS Social Care Partnership Trust

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OVERVIEW OF PRESENTATION

• CONTEXT OF SERVICE
• historical
• service configuration
• NEW SERVICE
• rationale
• provision
• POINTS FOR REFLECTION

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Current Service Arrangements

• Tier 3 historically provided by Mental Health
  Trust
• 11.8 WTE multidisciplinary
• Tier 2 provided by PCT
• 3.3 WTE therapeutic staff

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Tier 2 CAMHS

• Tier 2 provision began in Maidstone in 2003 when
  the Multi-Agency Interface Project MMAIP was
  set up
• This led to
• The development of a multi-agency single point
  assessment team (MMASPAT) linked to the local
  school cluster to provide a rapid response to
  schools who identified concerns for pupils
  emotional well-being and mental health
• The development of an Early Intervention and
  Prevention Tier 2 CAMH Service

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Multi-agency Single Point Assessment Team
Composition

• CAMHS Lead Nurse
• Consultant Clinical Psychologist CAMHS T2 3
• Social Worker (with children and families
  background)
• Senior Family Liaison Officer
• Behaviour Specialist Teacher/Educational
  Psychologist
• Joint Commissioning Officer (KCC)
• Associate Specialist in Community Paediatrics
• Referrals Administrator
• CAMHS Tier 3 Clinical Nurse Specialist

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Driving Forces for 2.5 clinic

• Desire to provide a seamless service for clients
  when CAMHS T2 T3 in different NHS Trusts
• Too much Referral Ping Pong
• Referrers scatter gun approach
• Wrong referrals had led to clients double
  waiting to receive appropriate intervention
• Clients/referrers did not understand different
  tiers they just wanted to be seen
• Demand capacity issues
• Duplication of paper work administrative time
• Information systems that could not talk to each
  other

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Aim of the new service To provide a seamless
CAMHS Tier 2/3 interface despite the two
services being provided by different NHS
Trusts.
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New Service summary

• Commenced February 2008
• Staffing - 7.5 hours per week of
• Clinical Nurse Specialist from
  existing T3 staffing
• T2 Consultant Clinical Psychologist
  new funding by T3.
• Activity
• Joint paper screening of all Tier 3 referrals
• Both clinicians attend at Tier 2 single point
  multi-agency assessment team meetings (joint
  screen of all T2 referrals)
• Joint in depth assessment for those referrals
  where it is not clear which service can most
  appropriately meet the clients needs. Followed
  by direct access to treatment in appropriate
  service without further assessment.
• Continued monitoring of a small number of clients
  where it remains unclear which service is
  required.

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Service objectives

• To ensure CAMHS Tier 2 and Tier 3 referrals are
  directed to the most appropriate service at the
  point of referral.
• To reduce the numbers of cases that may be
  sitting inappropriately on a waiting list and by
  doing so improve health outcomes.
•  To ensure the maximum use of limited CAMHS
  resources.
•  To reduce administrative resources required in
  transferring families from one service to
  another.

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Service objectives continued

• To promote successful working between child
  health, mental health and education via the
  virtual integration of Tiers 2 and 3.
•  To help provide more accurate demand and
  capacity data, which will provide evidence for
  the deployment of resources and service
  development.
• To identify the number of referrals, which do not
  meet, either Tier 2 or Tier 3 criteria, and the
  consequent gaps in service, to inform future
  commissioning discussions and planning.

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Evidence / Outcomes

• Since February 2008
• No clients assessed by other Tier 3 staff
  sent to other service
• No more client Ping Pong as no barriers to
  service access
• Referrers report satisfaction with new provision
• Word has spread outside of Maidstone!
• Service users accessing appropriate support
  faster
• Far more accurate demand data available for both
  services

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Issues / Concerns

• Funding currently temporary, need to secure
  permanent funding.
• Implementation of CAF and impact on single point
  assessment team.