Thank you to Sam Illaiee, Iuliana Eparu and Tracey Arthey from Waltham Forest CAMHS, North East London NHS Foundation Trust.
What was the problem you were trying to solve?
Ending treatment can be difficult for clinicians, particularly for children and young people who are considered to be at risk of harming themselves or other people. One example would be a young person who has received an intervention from Child and Adolescent Mental Health Service (CAMHS) where there are limited treatment outcomes and may be still self-harming. Clinicians might be wary of discharging this young person because of the high level of risk that their self-harm presents.
What was your solution?
We created a forum in which risky cases can be discussed, called our ‘THRIVE Clinic’. It provides an opportunity for the young person, their family and professionals involved in their care to come together and discuss the best possible way forward.
The clinic is made up of two senior clinicians from CAMHS and is held monthly. The clinic meets with the young person first before meeting the lead clinician holding the case, and the young persons’ families or carer.
A ‘THRIVE Plan’ is collaboratively developed as a result of the THRIVE clinic. The THRIVE Clinic addresses the following questions;
1. What is working well for the young person
2. What is not going well?
3. What are their support needs?
4. What happens if there is a crisis?
Answering these questions can help a young person and their network to see their crisis in perspective and may result in some cases agreeing to being discharged from CAMHS.
What kind out outcomes do you get from these meetings?
More than 50% of the cases that have been seen in the THRIVE Clinic so far have been discharged. In some instances where the young person has been at high risk even after being discharged the THRIVE clinic has provided CAMHS clinicians an opportunity to meet all the professionals involved in the young person’s care including the family/community network and contain their anxieties about the risk whilst developing a collaborative and multi-agency risk support or crisis plan as appropriate.
How is the clinic aligned to the THRIVE framework (Wolpert et al., 2016)?
The THRIVE clinic is well aligned to the ‘Getting Risk Support’ needs-based group of the THRIVE framework. These children, young people and their families are often those that do not benefit from further treatment but remain a significant concern and risk.
The THRIVE clinic aligns with the THRIVE framework by providing an opportunity for collaborative discussion between multi-agency professionals who are supporting the young person and their family, using open and shared decision making. These professionals come together in the clinic and devise a ‘THRIVE’ plan with the aim of reducing risk and/or harm. There is shared accountability and responsibility.
The clinic also gives the young person and their family an opportunity to work towards increasing their self-management, resilience and agency, all key aspects of the THRIVE framework.
For more information about the THRIVE clinic at Waltham Forest CAMHS please contact Sam.Illaiee@nelft.nhs.uk
Written August 2017.