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An example of a THRIVE-like service specification

Tarnia Woods, Head of Service for Child and Adolescent Mental Health Services (CAMHS) at North West Boroughs Healthcare NHS Foundation Trust presented a new CAMHS service specification at the i-THRIVE Community of Practice event on 12th October 2017. The specification was designed to be aligned to the THRIVE framework (Wolpert et al., 2016).

The specification covers four of the five localities the trust provides CAMHS for – Halton, Knowsley, St Helens and Warrington. Previously, there were separate service specifications for each of the four localities. The final specification is a result of strong collaborative work between the four clinical commissioning groups and NHS trust over the past year. The service specification was heavily influenced by engagement and co-design with children and young people in Warrington and Halton. You can read more about this here.


High-level overview

Getting advice and signposting

  • One to three contacts which end by mutual agreement. This level of support is sufficient to normalise behaviour and provide assurance or to provide full assessment to identify treatment goals/pathways.
  • The lead provider will:
    • Provide a system-wide approach with clinical leadership across the local authority area.
    • Deliver a rolling programme of core training
    • Implement a referral process to support self-referrals
    • Adopt a ‘no wrong front door’ approach
    • Develop a central emotional health and wellbeing hub.

Getting help

  • Children and young people who benefit from time-limited. goal-focused. Evidence-based interventions with clear aims.
  • The lead provider will:
    • Ensure there is a clear route in via ‘getting advice’ pathways
    • Provide interventions across a range of community-based school and health locations
    • Work in partnership with other partners to ensure a full range of evidence-based pathways
    • Ensure there is clearly defined and agreed direct access to pathways for children and young people in mental health crisis

Getting more help

  • To provide more intensive, specialist, evidenced-based interventions that aim to keep children and young people at home and prevent admission for those who experience severe mental health problems and those who are at high risk, where self-harm or severe conduct issues may feature.
  • The lead provider will:
    • Ensure there is a clear route in via ‘getting advice’ pathways
    • Ensure this is not a completely separate team to the other stages, with a flexible use of workforce
    • Provide goal-based, evidence-based interventions
    • Provide intensive, home-based treatments aligned to crisis pathways

Getting risk support

  • For those young people who are currently unable to benefit from evidence-based treatments but remain a significant risk or concern.
    The focus is a multi-agency approach, with joint processes to share and manage risk – ‘Team Around the Professional’
  • The lead provider will:
    • Develop robust integrated pathways in partnership with the local authority.
    • Ensure close working with education
    • Co-locate staff to facilitate joint working and share processes
    • Provide psychiatry oversight and support
    • Provide consultation and indirect support to children’s services
    • Work with colleagues to ensure an effective relationship based on the principles of therapeutic alliance to support improved outcomes
    • Joint approach to care planning for children and young people – identifying how best to keep themselves safe and what to do in a crisis.

Outcome framework

Alongside the service specification, a new outcome framework is under development. There has been a local shift in commissioning from being focused on activity to focusing more on outcomes. This outcome framework will be shared with the i-THRIVE Community of Practice when it is complete.


You can view and download the full service specification here. The needs assessments in the document are specific to Warrington but the service specification is the same across each locality.

 

For more information, contact Tarnia Woods at tarnia.woods@nwbh.nhs.uk.