The East London NHS Foundation Trust (ELFT) is the provider of child and adolescent mental health services in Newham, Tower Hamlets, Hackney, City of London, Luton and Bedfordshire. ELFT first chose to become an i-THRIVE accelerator site in order to support their service transformation aim of moving towards more integrated care, reducing barriers to access support and becoming more needs-led.
ELFT have focused on ensuring that their ‘Getting Advice and Signposting’ service is first class and are now giving advice to other accelerator sites about how they have improved this part of their service, with ELFT rated outstanding by the CQC in 2016.
Tower Hamlets in particular is working with local CCG commissioners in linking their trial of the Power Up app, developed by EBPU, with its CYP IAPT programme and its drive towards goal based outcomes, shared decision making and improvements in service user participation.
Implementation of the THRIVE Framework for system change (Wolpert et al., 2019) within Tower Hamlets CAMHS has progressed through:
1. Educating clinicians about the THRIVE Framework and a conceptual shift away from the tiered model: There is an ongoing programme of staff training events to discuss the THRIVE Framework and principles; with a particular focus on shared decision making. Clinicians have also attended the i-THRIVE Academy modules and will be involved in sharing these ideas with the wider team.
2. Embedding THRIVE Framework terminology and thinking into how clinical work is conceptualised: The needs based groupings of the THRIVE Framework were added to the Current View tool completed by every clinician when opening, reviewing and closing a case, as a way to embed THRIVE Framework thinking in how cases are conceptualised. ELFT is part of the CYPMH Currency Development pilot, which develops this categorising of cases further into need based groupings linked to the THRIVE Framework’s needs based groupings – this pilot began in April 2017.
Another initiative that has embedded the THRIVE Framework’s concepts and terminology has been the re-structuring of the service to reflect the THRIVE Framework. For example, the Triage Team has been redefined as the Front Door Team. This team has been more heavily resourced to operate effectively in meeting the needs of children and families considered to be ‘Getting Advice and Signposting’. The Front Door team conducts all the duties associated with meeting the needs of children and young people who are ‘Getting Advice and Signposting’ including consultation to the extended network and brief psychoeducation, assessment, intervention and advice on self-management. This has been a highly successful initiative that has reduced CAMHS waiting times to five weeks from the time a referral is received and decreased ‘did not attend’ rates despite reduced staff numbers and increased referrals. It has also improved the accessibility to CAMHS and ensured that we are able to proactively provide early support to both families and the wider network for a much larger cohort of families.
3. Supporting and monitoring shared decision making in routine clinical practice: The Goal Based Outcome tool was adapted (with permission from Dr Duncan Law) to include a shared care plan which was developed in consultation with young people. It was hoped that this would enhance collaborative practice and improve shared decision making.
To monitor the effectiveness of the shared decision making initiative the CollaboRATE measure was given on two separate occasions to a group of young people at the beginning of their work with CAMHS. On both occasions favourable feedback was received. The plan is to repeat this in six months to monitor if this has continued to improve.
These initiatives were supported by funding from the local CCG. Now that this has finished a group of clinicians have been identified to continue to support the implementation of the THRIVE Framework. One of the next steps is to share experiences and learning with partner agencies.
If you would like further information about ELFT’s work with i-THRIVE, please contact Dr Cathy Lavelle at firstname.lastname@example.org.