Hillarys Community CAMHS

Safety, Quality, Performance, Patient Experience and Patient Outcomes Report

1 July 2016 – 30 June 2017

CAMHS Senior Project Officer

Child and Adolescent Mental Health Service (CAMHS)

© Child and Adolescent Mental Health Services, Child and Adolescent Health Services, Department of Health 2016

Version: 1.0

Last Updated: April 2018

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Contents

1. Executive Summary 4

2. Community CAMHS 5

2.1 Hillarys Community CAMHS 6

2.2 Hillarys catchment overview 6

2.3 Staff 6

2.4 Capacity and demand modelling 7

2.5 Integration and shared care arrangements 7

2.6 Appointment scheduling 8

3. Referral Sources 9

4. Activity 10

5.1 Referrals 11

5.2 Access 12

5.3 Activations and Deactivations 16

5.4 Service Contacts (Occasions of Service) 20

5.5 Access by Aboriginal children and young people 21

5.6 Number of treatment sessions per episode of care 23

6 Safety and Quality 25

6.1 Documentation Audit Results 25

6.2 Internal Audit Results 26

6.3 Clinical Incidents 26

6.4 Risks 26

6.5 Quality Improvements 27

7 Education and Training of staff 28

7.1 Mandatory Training 28

8 Consumer and carer experience 29

8.1 Experience of Service Questionnaire (ESQ) 29

8.2 Complaints and Compliments 29

9 Patient Outcomes 31

9.1 NOCCS 31

10 Policy 32

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1. Executive Summary

Hillarys Community CAMHS provide services to the Hillarys catchment area for infants, children and young people, up to their 18th birthday with severe and/or complex emotional and mental health wellbeing concerns. The service serves an estimated population of approximately 34571 young people aged from 0 to 17 years old with 11.2 FTE (Full Time Equivalent) staff. The Hillarys CAMHS team is comprised of a number of clinical disciplines and an administrative team, who are led by a Consultant Child and Adolescent Psychiatrist and Service Manager.

Hillarys Community CAMHS has a number of key partnerships with other services in the local area, both internally and externally. The Service Manager and Head of Service of Hillarys CAMHS also sit on a number of consortium and collaborative groups, such as the WA Statewide Medicines Formulary, Mental Health Sub Network, and Headspace Consortium, which has allowed the team to develop strong interagency relationships.

In the last financial year, Hillarys CAMHS received an average of 26.2 referrals each month. The referrals were most commonly from external medical practitioners. The median wait time from referral to a Routine Choice appointment was 21.5 days and from Choice to Partnership (treatment) was 21 days. Hillarys CAMHS activated approximately 8 new clients per month and deactivated approximately the same number. The median number of treatment sessions per episode of care was 12, and the Interquartile range (IQR) 14 sessions.

An internal documentation audit conducted at Hillarys CAMHS in the last financial year generated recommendations that have all been completed. One clinical incident was reported at Hillarys during this period which, following investigation, did not generate any service improvement opportunities. The Hillarys CAMHS team maintains its level of compliance with mandatory training at the level expected of Community CAMHS teams. The team also undertook clinical outcome measures training in October 2016.

Hillarys CAMHS actively seeks consumer feedback via an Experience of Service Questionnaire (ESQ). In the last financial year 107 children and adolescents and 148 parents/carers provided feedback via the ESQ. In response to the ESQ’s, feedback posters that describe the actions taken are displayed in the Hillarys CAMHS waiting area. In this period, Hillarys CAMHS received no formal complaints and no formal compliments, although many informal compliments were logged through the ESQ process.

Through their extensive involvement in the policy development process within CAMHS, the Hillarys CAMHS Service Manager and Head of Service have helped the team develop a strong focus on policy implementation, compliance, and review.

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2. Community CAMHS Community CAMHS provide services for infants, children and young people under 18 years of age who have severe and/or complex emotional and mental health wellbeing concerns which are causing them to experience substantial impairment in functioning on a continuous or intermittent basis. Community CAMHS services are located throughout the Perth metropolitan area, staffed by multidisciplinary teams who offer evidence-based individual, family and group interventions.

In working together with children, young people, families and support networks, Community CAMHS supports them to become decision-makers in their own care, implementing the principles of recovery-oriented child and adolescent mental health practice. Recovery oriented practice supports and recognises the following:

The uniqueness of the individual;

Real choices;

Attitudes and rights;

Dignity and respect; and

Partnership and communication.

Key principles for service delivery:

Provides a holistic framework that informs all contact with children, young people and families;

Builds and enhances strength, resilience and social well-being;

Supports children to return to a normal developmental trajectory;

Is underpinned by the premise that children and young people do recover from mental health problems;

Engages with all areas of the child, young person and family’s life, including relationships, education, vocation and leisure; and

Informs the recovery plan that is regularly reviewed by the child or young person, family and multidisciplinary team.

Children and adolescents often present with complex, multifactorial problems. The reason for entry to CAMHS must relate to mental health problems, although other concurrent and/or associated difficulties may exist (e.g. autism, intellectual disability, child protection issues). The range of presenting problems usually considered on referral includes:

Persisting suicidal ideation and/or behaviour;

Severe risk-taking behaviour (including self-harm);

Psychotic symptoms;

Depressed, sad and/or agitated mood;

Severe and persisting behavioural and conduct disturbance;

Severe and persisting peer and/or family problems leading to significant emotional distress and/or behavioural problems;

Persisting and severe school avoidance and/or phobia;

Severe anxiety (e.g. phobias, post-traumatic stress disorder);

Severe obsessions and compulsive rituals;

Eating and body image disturbances; and

Complex ADHD with co-morbid emotional / mental health wellbeing concerns.

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2.1 Hillarys Community CAMHS

Hillarys Community CAMHS was established in 2001. It is located at Shop 2/3, Level D, Endeavour Business Centre, 32 Endeavour Road, Hillarys.

2.2 Hillarys catchment overview

The total estimated population in the Hillarys Catchment in 2012 was 153,240 based on projections from the Australian Bureau of Statistics (ABS) data. Of the total population, 34,571 were aged between 0 – 17 years old. The estimated 0-17 year old Aboriginal population in the Hillarys catchment in 2012 was 459 (data based on ABS data and planning data by the CAHS Epidemiology team).

Total population, population by age

Hillarys Community CAMHS

Total Population Population of 0 - 17 year olds

Population of Aboriginal 0 - 17 year olds

153, 240 34, 571 459

2.3 Staff

Hillarys Community CAMHS is comprised of a multidisciplinary team with members from Child Psychiatry, Clinical Psychology, Nursing, Social Work and Administration. The team is led by the Service Manager and Head of Service. The Service Manager has responsibility for the financial, physical and human resources and works in partnership with the Head of Service (the Child Psychiatrist) in providing clinical governance, together ensuring the delivery of an integrated child and adolescent mental health service based on a community-driven and consumer-focused model of care. The FTE breakdown at Hillarys CAMHS is shown in the below table.

Staff and FTE, Hillarys CAMHS, June 2017

Hillarys CAMHS staff FTE Note

Nursing Services 2.8 Increased from 1.1 FTE in January 2017 due to integration of acute staff into team.

Admin & Clerical 2.0

Service Manager 1.0

Medical Support Services 3.6 Includes temporary 0.6 FTE from Suicide Response funding

Medical - Salaried 1.00

Child Protection Consultation Liaison 0.4

CAMHS Education Liaison Teacher 0.4

TOTAL Service FTE 11.2

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2.4 Capacity and demand modelling

The ratio of available clinical FTE per total population is used as a way of describing capacity of mental health services to adequately service a population. A ratio of 14 clinical FTE per 100,000 total populations has been used in Queensland as a goal which would create sufficient capacity for a child and adolescent mental health services to meet known demand for service for children with severe and complex mental health disorders.

Suggested capacity of specialist mental health services to meet demand It has been estimated that 3.2% of children and adolescents experience a severe mental health disorder in a

one year period, which for Hillarys would mean a group of 1106 children and adolescents experiencing a

severe mental health disorder in a one year period.

Specialist mental health services have previously met demands of 1% of the 0-17 year old population,

converting to an estimate of 346 children in the Hillarys area.

Population and FTE actual staff ratios

*This includes 2.8 FTE Nursing and 3.6 FTE medical support.

2.5 Integration and shared care arrangements Children, young people and families are recognised as being part of a wider community and Community CAMHS are viewed as one element in a wider service network. Each Community CAMHS collaborates and develops partnerships within all areas of CAMHS (Community, Acute and Specialised) and externally with other service providers to facilitate coordinated and integrated services for children, young people and their families. Community CAMHS also provides consultation liaison with primary care partner agencies and all other key stakeholders.

Key partnerships:

The Child Development Service (CDS) is part of the Child and Adolescent Health Service, providing a range of support services for children, with or at risk of developmental difficulties, and their families. Hillarys CAMHS meets monthly with their local CDS clinic to discuss recent trends and individual cases.

The Department for Communities, Child Protection and Family Support (CPFS) provides a range of child safety and family support services to West Australian individuals, children and their families, from the Kimberley to the Great Southern regions of the State. Hillarys CAMHS meets monthly with their local CPFS service to discuss recent trends and individual cases.

Department of Education – Hillarys CAMHS holds regular case conferences with local schools (both Government and non-Government) to discuss individual cases.

Statewide Specialised Aboriginal Mental Health Service (SSAMHS) – Although Hillarys CAMHS does not have a designated SSAMHS worker, the team has a close relationship with the SSAMHS worker at Clarkson Community CAMHS and is able to

Total population

Clinical FTE Clinical FTE per 100,000

Recommended FTE for Hillarys population

Hillarys CAMHS

153,240 6.4* 4.2 21.5

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draw on the Clarkson team for support where required. The Service Manager of Hillarys CAMHS also chairs the CAMHS SSAMHS Steering Group.

CAMHS Acute, Specialised and Community Directorates – As the Multi-Systemic Therapy program is located in close proximity to Hillarys CAMHS, the two services have developed a strong working relationship. Hillarys CAMHS also works closely with both Clarkson and Warwick Community CAMHS as these teams have a number of joint stakeholders (including Child Protection, General Practitioners, and CDS).

Joondalup Hospital – Hillarys CAMHS liaises with the Joondalup Hospital Emergency Department (ED) on a regular basis. Hillarys CAMHS are currently working with Clarkson CAMHS to provide teaching and training to Joondalup ED mental health staff.

Headspace – The Hillarys CAMHS Choice Coordinator attends regular clinical meetings at the local Headspace service. The Service Manager of Hillarys CAMHS also attends the Headspace consortium on a bimonthly basis.

Other NGO’s – Hillarys CAMHS has been able to develop a strong relationship with Helping Minds as a result of being located in close proximity with this service. Hillarys also works closely with Mission Australia on a number of cases.

Mental Health Sub Network – The Hillarys CAMHS Head of Service is a member of the Mental Health Sub Network for Neuropsychiatry and Developmental Disability. This group undertakes specific tasks to support documentation of care pathways, models of care, clinical guidelines, service planning, service development and service improvements for those with neuropsychiatric and developmental disabilities.

The Head of Service Hillarys CAMHS is also a member of the Expert Advisory Group for the WA Statewide Medicines Formulary.

2.6 Appointment scheduling

The workload of clinical staff is managed by allocating resources to choice and partnership appointments. The allocation of choice and partnership appointments varies for different staff members depending on their role, i.e. some staff provide more choice appointments and others more partnership appointments. Overall more choice appointments are provided than partnership appointments, since not all children and families progress to partnership. Hillarys CAMHS schedule approximately 39 urgent Choice Appointments and 65 routine Choice appointments per 13 week cycle. Hillarys CAMHS schedule approximately 46 initial Partnership Appointments per 13 week cycle.

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3. Referral Sources

Referral Source Number of Referrals Received

Percentage of Referrals Received

MEDICAL PRACTITIONER 143 46.7%

OTHER ORGANISATION* 2 0.7%

NGO 8 2.6%

CDS 14 4.6%

CPFS 4 1.3%

SCHOOL 49 16.0%

HOSPITAL (INCLUDING EMERGENCY DEPARTMENT)

44 14.4%

INTERNAL PROGRAM 24 7.8%

UNKNOWN 0 0.0%

FAMILY / FRIEND 0 0.0%

OTHER PROFESSIONAL 13 4.2%

SELF 2 0.7%

EXTERNAL PROGRAM 3 1.0%

Grand Total 306 100%

*This category includes: Child Witness Service; Neurosciences Unit

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4. Activity Notes about activity graphs:

All graphs reflecting referral numbers, activations, deactivations and occasions of service show a trend that is apparent across all Community CAMHS service, whereby activity is heavily influenced by school holiday periods (April, July, October, December/January).

Control Charts: Control charts have two general uses in the management and continuous improvement of a service The most common application is as a tool to monitor specific processes and functions to check for stability and control. A less common but potentially more powerful use is as an analysis tool. Data is plotted in time order. A control chart always has a central line for the average, an upper line for the upper control limit and a lower line for the lower control limit. These lines are determined from historical data. By comparing current data to these lines, you can draw conclusions about whether the process variation is consistent (in control) or is unpredictable (out of control, affected by special causes of variation). If your data points are within the upper and lower control limits they are in control, if they are above or below then they are out of control. Service Managers can use control charts to monitor the variation over a period of time for the number of days that each child and family waits for an appointment. Remarkable levels of variation and trend might indicate a change in the process or increase in referrals received.

Box and whisker plots: A box and whisker plot is used to display information about the range, the median and the quartiles. In descriptive statistics, the IQR, also called the midspread or middle 50%, is a measure of statistical dispersion, being equal to the difference between 75th and 25th percentiles, or between upper and lower quartiles. In the box and whisker plots, our middle 50% is represented by the two grey boxes.

Scatter Plots: Scatter plots are similar to line graphs in that they use horizontal and vertical axes to plot data points. However, they have a very specific purpose. Scatter plots show how much one variable is affected by another. The relationship between two variables is called their correlation. Scatter plots usually consist of a large body of data. The closer the data points come when plotted to making a straight line, the higher the correlation between the two variables, or the stronger the relationship. If the data points make a straight line going from the origin out to high x- and y-values, then the variables are said to have a positive correlation. If the line goes from a high-value on the y-axis down to a high-value on the x-axis, the variables have a negative correlation.

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5.1 Referrals

This control chart shows:

Referrals – the total number of referrals received each month.

Average – the average number of referrals received each month over the reported period (26.2).

Control Limits – control limits are set three standard deviations above and below the mean.

This graph demonstrates that Hillarys CAMHS had an average of 26 referrals per month. Peaks and troughs generally correlate with school terms. This is an increase from the previous financial year, when the average was 20 referrals per month.

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5.2 Access Receipt of Referral to Choice Hillarys CAMHS has a broad access policy. Referrals are accepted from a wide range of stakeholders including self-referrals. All referrals are reviewed within one business day and processed according to clinical urgency. In urgent cases, families are contacted by phone within one to two business days and offered the opportunity to book into an urgent Choice appointment within a clinically appropriate timescale. For less urgent referrals the family is contacted by letter and invited to phone to book into a routine Choice appointment at a time which is convenient for them. They can also choose a suitable time for other agencies or supports to join for the Choice appointment. It is not uncommon for families to reject the earliest available Choice appointment time and arrange an appointment for a later date, due to family disruptions or the need to make personal arrangements (for example, negotiate time off work). For most of the reporting period, the time from Referral to Choice appointment was considerably less than the consumer specification. The first graph shown below is a box and whisker plot. The consumer specification line is set to 28 days in order to provide a visual representation of how soon most young people and their families expect to access our community services. This graph shows that the Median wait time for Choice was 21.5 days. Interquartile range (IQR) is 20 days. The second graph is a control chart. This shows:

Access time (orange line) – represents wait times from referral to choice over time, each dip and spike represents an individual young person’s wait times.

Median – the median wait time from receipt of referral to choice over the reported period (21.5 days).

Control Limits – control limits are set three standard deviations above and below the mean.

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Choice to Partnership

After the Choice appointment, if it is jointly decided that Hillarys CAMHS is the best service to meet the clinical needs of the young person and family, then an initial Partnership appointment date and time is provided at the end of the Choice appointment. The timing of this is determined by clinical acuity, therapeutic needs and the wishes of the family. It is not uncommon for families to reject the earliest available Partnership appointment time and arrange an appointment for a later date, due to family disruptions or the need to make personal arrangements (for example, negotiate time off work). The first graph shown below is a box and whisker plot. This graph shows that the Median wait time from Choice to Partnership was 21 days. Interquartile range (IQR) is 28 days. The second graph is a control chart. This shows:

Access time (purple line) – represents wait times from Choice to Partnership over time, each dip and spike represents an individual young person’s wait times.

Median – the median wait time from receipt of choice to partnership over the reported period (21 days).

Control Limits – control limits are set three standard deviations above and below the mean.

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5.3 Activations and Deactivations

This control chart shows:

Activations – the total number of activations each month.

Mean – the mean number of activations each month over the reported period (8.6).

UCL – the upper control limit is set three standard deviations above the mean.

LCL – the lower control limit is set three standard deviations below the mean.

Top 10 principal activation codes 2016/17 FY:

Principal Activation Diagnosis Case Count

Moderate depressive episode 26

Mixed anxiety and depressive disorder 19

Disturbance of activity and attention 6

Social phobias 6

Adjustment disorders 5

Generalised anxiety disorder 5

Mild depressive episode 5

Childhood emotional disorder, unspecified 4

Post traumatic stress disorder 4

Separation anxiety disorder of childhood 4

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Top 10 International Classification of Disease (ICD) 10 codes at activation in 2016/17

ICD 10 Codes

Activation Diagnosis Number of Activations

F32.1 Moderate depressive episode 26

F41.2 Mixed anxiety and depressive disorder 19

F40.1 Social phobias 6

F90.0 Disturbance of activity and attention 6

F32.0 Mild depressive episode 5

F41.1 Generalised anxiety disorder 5

F43.2 Adjustment disorders 5

F43.1 Post traumatic stress disorder 4

F93.0 Separation anxiety disorder of childhood 4

F93.9 Childhood emotional disorder, unspecified 4

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This control chart shows:

Deactivations – the total number of deactivations each month.

Mean – the mean number of deactivations each month over the reported period (8.2).

UCL – the upper control limit is set three standard deviations above the mean.

LCL – the lower control limit is set three standard deviations below the mean.

Top 16 principal deactivation codes 2016/17 FY:

Principal Deactivation Diagnosis Case Count

Mixed anxiety and depressive disorder 21

Moderate depressive episode 21

Childhood emotional disorder, unspecified 6

Post traumatic stress disorder 6

Disturbance of activity and attention 4

Generalised anxiety disorder 4

Social phobias 4

Adjustment disorders 3

Mixed obsessional thoughts and acts 3

Anxiety disorder, unspecified 2

Disinhibited attachment disorder of childhood 2

Mild depressive episode 2

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Principal Deactivation Diagnosis Case Count

Other specified problems related to primary support group 2

Predominantly obsessional thoughts or ruminations 2

Separation anxiety disorder of childhood 2

Unspecified behavioural and emotional disorders with onset usually occurring in childhood and adolescence

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Top 16 ICD 10 codes at deactivation diagnoses in 2016/17

ICD 10 Codes

Deactivation Diagnosis Number of Deactivations

F32.1 Moderate depressive episode 21

F41.2 Mixed anxiety and depressive disorder 21

F43.1 Post traumatic stress disorder 6

F93.9 Childhood emotional disorder, unspecified 6

F40.1 Social phobias 4

F41.1 Generalised anxiety disorder 4

F90.0 Disturbance of activity and attention 4

F42.2 Mixed obsessional thoughts and acts 3

F43.2 Adjustment disorders 3

F32.0 Mild depressive episode 2

F41.9 Anxiety disorder, unspecified 2

F42.0 Predominantly obsessional thoughts or ruminations 2

F93.0 Separation anxiety disorder of childhood 2

F94.2 Disinhibited attachment disorder of childhood 2

F98.9 Unspecified behavioural and emotional disorders with onset usually occurring in childhood and adolescence

2

Z63.8 Other specified problems related to primary support group

2

Missing Not in PSOLIS 2

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5.4 Service Contacts (Occasions of Service)

This control chart shows:

OOS – the total number of occasions of service completed each month.

Mean – the mean number of occasions of service completed each month over the reported period (305).

Control Limits – control limits are set three standard deviations above and below the mean.

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5.5 Access by Aboriginal children and young people

Please note that if a young person is not identified in the Patient Administration System (PAS) as Aboriginal then we have no way of identifying them in our reports. This control chart shows:

Referrals – the total number of referrals received for Aboriginal young people each month.

Mean – the mean number of referrals received for Aboriginal young people each month over the reported period (0.25).

Control Limits – control limits are set three standard deviations above and below the mean.

One Aboriginal young person was activated at Hillarys CAMHS in the reporting period. Of note, there are only 459 Aboriginal 0-17 year olds in the catchment area and no dedicated SSAMHS worker at Hillarys CAMHS. .

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Please note that if a young person is not identified in the Patient Administration System (PAS) as Aboriginal then we have no way of identifying them in our reports. This control chart shows:

OOS – the total number of occasions of service completed for Aboriginal young people each month.

Mean – the mean number of occasions of service completed for Aboriginal young people activated each month over the reported period (3).

Control Limits – control limits are set three standard deviations above and below the mean.

One Aboriginal young person was activated at Hillarys CAMHS in the reporting period. Of note, there are only 459 Aboriginal 0-17 year olds in the catchment area and no dedicated SSAMHS worker at Hillarys CAMHS.

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5.6 Number of treatment sessions per episode of care

The above graph only includes a count of the following service event items:

Assessment

Assessment Baseline

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Assessment Final

Assessment Initial

Assessment Mid-Treatment

Medication Review

Therapy The box and whisker plot shows that the median number of treatment sessions per episode of care is 12. The Interquartile range (IQR) is 14 sessions. The scatter plot shows length of stay in months on the y axis and number of treatment sessions per episode of care on the x axis.

For each young person the number of sessions is determined on a clinical basis, keeping in mind the relevant clinical standards. Multi-disciplinary team meetings together with individual clinician work plan meetings ensure that the number of sessions is matched with clinical quality and recovery of the young person and family.

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6 Safety and Quality

6.1 Documentation Audit Results

Quality mental health care is dependent on good clinical documentation. Assessment and diagnosis requires detailed information, often obtained from a range of sources. Care may be provided by a team of multidisciplinary clinicians, and frequently after hours or in emergency settings. Clinical information needs to be accurately communicated quickly and clearly. Standardised forms are one way of ensuring common reporting standards and equity of use across services.

In 2012, representatives from across WA Health agreed to a set of standardised forms to be implemented across the State. The forms developed span the various processes that are completed as part of the overall mental health assessment process, from triage to discharge.

These forms are known as the Statewide Standardised Clinical Documentation (SSCD) suite. It is acknowledged that the forms were developed by New South Wales Health, and that the WA Government was granted permission to use the forms across public mental health services.

The purpose of the documentation audit is to assess the degree of implementation and compliance with SSCD documentation within CAMHS services. The results help to identify areas where improvements can be made.

There were two documentation audits undertaken at Hillarys CAMHS between 1 July 2016 – 30 June 2017. Audits were undertaken in October 2016 and February 2017.

Results from the more recent audit of February 2017 audit are summarised in the table below:

Audit Area Number of actions against areas of low compliance

Comments Actions completed (yes/no)

Medical record ‘basics’ (16 criteria

2 1.Documentation standards to be discussed in team business meeting

2.Complete one file audit live in each team meeting

Yes

Yes

Individual Management Plan/Recovery Plan (26 criteria)

1 1.A reminder to be added to the team meeting proforma to aid identifying where this has not yet been completed.

Yes

Risk assessment (10 crteria)

1 1. A reminder to be added to the team meeting proforma to include date of last RAMP completed.

Yes

Discharge Planning (19 criteria)

1 1. Written reminders to all clinicians of the requirements to involve young people in

Yes

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Audit Area Number of actions against areas of low compliance

Comments Actions completed (yes/no)

discharge planning process, and for discharge plans to be signed with a copy to family and young person.

2. To be discussed at the team Business meeting.

Yes

6.2 Internal Audit Results

The CAHS Internal Audit (IA) Program assesses nominated areas throughout CAHS against the National Safety and Quality Health Service Standards (NSQHSS) and where relevant the National Standards for Mental Health Services (NSMHS). The audit aims to provide feedback on current progress, identify gaps, provide recommendations, and highlight achievements.

Audit interviews take place during the 4th week of the month. Princess Margaret Hospital have elected to undergo two interviews per month, CAMHS one per month, and CACH one every alternate month.

Hillarys CAMHS will complete an internal audit in October 2017 covering both the National Standards for Mental Health Services (NSMHSS) and National Safety and Quality Healthcare (NSQHS) Standards.

Further information regarding the standards can be found at the following links: https://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards/ http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-n-servst10

6.3 Clinical Incidents

No Severity Assessment Code (SAC) 1 or SAC 2 incidents occurred at Hillarys CAMHS in the reporting period. One SAC 3 was recorded during this period. This incident involved a young person’s parent choosing to administer a different dosage of the young person’s medication than was prescribed by the clinic. Hillarys CAMHS attempted to educate the young person’s family regarding the importance of adhering to prescribed dosages and also made contact with the young person’s General Practitioner to advise of the incident. No service improvement opportunities were identified from this incident.

6.4 Risks

There were no specific risks relating to Hillarys CAMHS recorded on the CAMHS Risk Register during the reporting period. Two generic Community CAMHS risk were listed on the risk register during this period:

Failure of CAMHS community facilities meeting mental health standards which was activated in 2012. This risk was ranked as high during this period.

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Inadequate and invariable access to Community CAMHS services. This risk was ranked as high during this period.

Treatment Action Plans (TAPS) were in place to mitigate the risks throughout the reporting period.

6.5 Quality Improvements

During the period 1 July 2016 to 30 June 2017 Hillarys CAMHS undertook a range of activities aimed at improving the quality of service they provide to their consumers. These included:

Provision of family therapy sessions;

Initiation of a physical health clinic;

Integration of urgent response into business; and

Introduction of Adolescent Mentalisation Based Integrative Therapy (AMBIT) framework for complex case discussions

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7 Education and Training of staff

7.1 Mandatory Training Mandatory Training completion statistics from iLearn as of 2 August 2017

Mandatory training name Employee count

Percentage not

complete

Percentage is complete

Narrative (where required)

CAHS induction 12 0% 100%

Aboriginal cultural learning 12 8% 92%

Accountable and ethical decision making

12 8% 92%

Aiming for zero harm 12 33% 67%

This training only became mandatory in February 2017.

Aseptic technique

4 50% 50%

Compliance is low due to problems accessing practical training on site.

Australian Mental Health Care Classification 10 60% 40%

This training only became mandatory in December 2016.

Basic life support

12 75% 25%

Compliance is low due to problems accessing practical training on site.

Clinical handover 9 11% 89%

Emergency Management - Community

12 83% 17%

Compliance is low due to problems accessing practical training on site.

Hand hygiene 12 50% 50%

Infection control principles 9 0% 100%

Mandatory reporting of child sexual abuse

4 0% 100%

Manual Tasks 12 67% 33%

Medication Safety 4 50% 50%

Open Disclosure Clinical 5 20% 80%

Open Disclosure Introduction 6 33% 67%

Patient and family centred care 9 22% 78%

Record keeping awareness 12 25% 75%

WA Mental health act 10 10% 90%

Workplace aggression and violence 12 75% 25%

NB: In the second two quarters of 2017 the Hillarys team focussed on improving their mandatory training compliance. As of 9 March 2018, Hillarys CAMHS overall compliance with mandatory training is at 92%.

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8 Consumer and carer experience

8.1 Experience of Service Questionnaire (ESQ)

The use of the Experience of Service Questionnaire (ESQ), has enabled front line staff and the management team to better understand the way in which the service respond to the needs of children and families in Hillarys. Originally developed by the Commission for Health Improvement (CHI) in the UK and adapted for use in CAHS CAMHS, the Experience of Service Questionnaire (ESQ) is a 15-item self-completion questionnaire that assesses users’ views of services with respect to accessibility, humanity of care, organisation of care and environment. The ESQ can be completed by parents/carers, children and young people and is anonymous.

During the period 1 July 2016 – 30 June 2017, 107 children and 148 parents provided feedback via the ESQ.

Hillarys Community CAMHS inform children, young people and their families of the changes made as a result of ESQ feedback via ‘You spoke, we listened’ posters, which are displayed throughout the clinic. An example of a recent ‘You spoke, we listened’ poster is below:

8.2 Complaints and Compliments There were no formal complaints or compliments recorded in the Datix Consumer Feedback Module for Hillarys CAMHS during the reporting period.

9 - 11 years 16

12- 18 years 91

Parent/Carer 148

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The ESQ provides an opportunity for parents, children and young people to make comments about the service provided to them by Hillarys CAMHS. The following are examples of the informal compliments received by Hillarys CAMHS through this process: From parents: Very professional - feels like we're in good hands Thanks so much for your help, super service from the clinician and Dr. Very valuable Keep up the great work, Thanks Really felt heard, acknowledged the positives in what we are doing to help our son and gave us feedback and future steps. Very appreciative of this opportunity to attend - thankyou From 12-18 year olds: You are all great people Thank you for telling me all my options and giving me great advice for the future. The clinician was really caring and was really understanding I loved the lady I had, very kind From 9-11 year olds: It was awesome Today was really fun here and was great

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9 Patient Outcomes

9.1 NOCCS

NOCC, and in particular the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), may be used to fund episodes of care on a national level from the beginning of the 2017 financial year. NOCC training was identified as a gap in the training currently delivered face to face in Community CAMHS, as the online training package gave clinicians little opportunity to practice rating and no opportunity to discuss the clinical vignette with colleagues and managers. With the objective of training Community CAMHS clinicians in the clinical rating tools and embedding the scores into clinical management plans to improve services delivered to children, young people and their families/carers, a project was initiated to provide NOCC training and clinical utility training workshops to all CAMHS clinical staff that are responsible for completing NOCC measures. It was decided that special attention would be given to the HoNOSCA and ensuring that ratings given in this measure are reflected in clinical management and crisis management plans. Hillarys Community CAMHS staff completed this new training on 13 October, 2016.

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10 Policy

New/reviewed policy documents are implemented at Hillarys CAMHS via: o Email to all team members; o Subsequent discussion at team business meetings; and o Completion of Document Awareness Notification Forms.

Recently released policy documents that have been discussed and implemented at team level include:

o Operational CAMHS policy document CAMHS Leave Backfill

o Clinical CAMHS policy documents: CAMHS Clinical Assessment - updated CAMHS Access - updated CAMHS Managing Clinical Risk After Disclosure of Child Sexual Abuse CAMHS Sexual Safety Guideline CAMHS Shared Care Guideline (inclusion of information sheet for children and

families) CAMHS Temporary Electronic Storage Of SSCDs and MHA forms

o Acute CAMHS policy document CAMHS Inpatient Unit Entry Protocol

o Community CAMHS policy document: Community CAMHS Multidisciplinary Team Review Guidelines – updated to

include reference to shared care The Service Manager and Head of Service at Hillarys CAMHS have both been heavily involved in the policy development process, with the Service Manager acting as a member of the CAMHS Policy and Procedures Steering Group and the Head of Service participating the involvement of a number of key clinical policies.

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