Trust introduces Child and Adolescent Home Treatment Team to support young people with complex mental health problems, reducing the need for out-of-area treatment and contributing to an outstanding CQC rating

Synopsis:

The newly formed Child and Adolescent Home Treatment Team (HTT) was established to minimise the impact of in-patient admission for young people aged 13-18 with complex mental health problems. Their remit is to offer an alternative, by supporting these young people in the community and the comfort of their home environment whenever possible. Where a young person has needed to be admitted, the team works hard to discharge them as quickly as possible with a robust care and safety plan.

The team has introduced emergency 72 hour, seven day and four-week admissions, enabling the team to support the family through a shorter admission. This also encourages resilience within the young person and their support network, rather than promoting an overdependency on professionals. This has resulted in less disruption to their schooling, friendships and family relationships etc. It allows young people to feel more in control of their own lives, but with the security of knowing they have access to the right support when they need it. Since introducing HTT, numbers of youngsters in out of area adolescent beds has reduced to zero and average lengths of stay have reduced by 42 per cent.

Ambitions:

Prior to the HTT, the average length of stay was 81 days and there were an average of 40 young people being treated out of area. Goals are to prevent the need for inpatient treatment if possible by providing intensive support to young people in the community. They also aim to reduce the lengths of stay for service users who need to be admitted and reduce the numbers of service users requiring inpatient treatment out of area. Initial challenges whilst establishing this new service have never been seen as an obstacle.

Every team member is solution-focused with a “can do” attitude. The main and ongoing challenge is recruitment. Despite initially being able to recruit to just half of the nursing vacancies, the team has been able to hold the caseload originally agreed. With the addition of two new starters and further recruitment, the team is keen to further increase its caseload. Another challenge has been the amount of communication work necessary to promote the remit of the new team and its limitations, both internally and with external partners including social care. Ideally, more time and resources for this work should have been included in the business case.

Outcomes:

The service has been rated as Outstanding by the CQC this year. Numbers of youngsters in out of area adolescent beds is currently zero and average lengths of stay have reduced by 42 per cent from 81.3 days to 47.6 days. Prior to formation of the HTT an average of 40 young people were receiving inpatient treatment out of area. This has now reduced to zero and only those young people needing specialist beds not available in Hertfordshire e.g. Low secure, PICU and under 13s will receive care outside of area – currently nine of our service users.

Outcome Measures reports are attached which demonstrate a significant overall improvement in young people’s mental health. Specific areas of excellence rated by young people included: How kind and caring the team was in supporting and understanding their difficulties and collaborating in their care.

Feedback from parents/carers were positive, particularly around the intensive support they received from staff who were relaxed, positive, helpful and incredibly lovely. It is evident that both young people and their parents/carers are satisfied. This is reflected in the positive outcomes from young people, their families and clinicians regarding the care and treatment received and clinical improvements in mental health at discharge.

Spread:

CAMHS HTT shares their unique model to improve services across the country. HPFT is a New CareModels (NCM) site and in regular communication with other NCM sites and quarterly NCM conferences to exchange ideas, skills, and knowledge. HPFT has presented on two occasions ensuring good practice is shared. The team is also in regular communication with Lincolnshire partnership NHS Trust who’ve visited HTT for advice on the development of their model and has presented at Eastern Regional meetings.

The team has built a great reputation amongst colleagues in other agencies such as social care, where their input has made all the difference by supporting social workers to continue with a case and prevent placement breakdown. Cases have included young people who have transferred directly from LowSecure Units back to the community and Psychiatric Intensive Care Unit (PICU) services. By working with the HTT, they have avoided step down into an acute bed and have been supported to return home. This may involve carrying out up to three visits a day, seven days a week in order to keep the service user at home, but we are seeing amazing results. See comments in latest CQC report p17-18 on attachment p45-46.

Value:

Numbers of youngsters in out of area adolescent beds is currently zero and average lengths of stay have reduced by 42 per cent. Outcome Measures reports attached. Feedback from: Simon Pattison, HoS, Integrated Health and Care Commissioning Team, Working on behalf of East and North Hertfordshire CCG, Herts Valleys CCG and Hertfordshire County Council: “The HTT has made a really positive difference in keeping young people with mental health issues out of inpatient beds and supporting them better in the community.

It has become an integral part of the local network of support for these complex young people.“Parents and young people feedback and case-study as below and in separate attachment: pages 47-63.” Our only regret is that the HTT didn’t exist when **** was first ill.”

The Home Treatment Team is absolutely vital. It has prevented the need for admission and given ****and us the appropriate support at home. HTT allows the family to stay together and have helped us to understand challenges better. We know that this service is relatively new but it has definitely proved with us that it works wonders”.”Thanks so much again. ****managed a job interview this week and started college yesterday, then went for dinner immediately after”.

Involvement:

There has been a systemic approach involving young people and their parent(s)/carer(s) with input from the multidisciplinary team (MDT - nursing team, medical, social and therapy team). Despite competing demands and pressures, staff are compassionate and professional in their approach with service users, carers and each other. At HPFT there is an active Youth Council. The Youth Council was consulted right from the outset in October 2017, when the business case for HTT was being developed.

The Youth Council has been involved throughout the process and this continues. Our Young People are currently co-producing a new information leaflet on the service. We have a multi-disciplinary and multi-agency NCM Steering Group and Project Board and work closely with a range of external partners, young people and careers. The Team support many other professionals such as social care colleagues in their work with a young person and offer a consultative role as well as being very much hands-on.