The document outlines the development of Liverpool's integrated CAMHS partnership over time. It summarizes: 1) The partnership has expanded from a single provider model to include voluntary sector organizations, with the goal of providing a continuum of mental health care. 2) Key milestones included establishing a single point of access, multi-agency triage, and more community-based services. 3) Current priorities include further implementing evidence-based practices, improving participation, and transforming services through the CYP IAPT program to improve outcomes for children and families.

1. An Integrated CAMHS Pathway
Liverpool CAMHS Partnership
Lindsey Marlton
CAMHS Service Manager
Alder Hey Children’s NHSFT
Lindsey.marlton@alderhey.nhs.uk
Monique Collier
CEO Young persons Advisory Service
monique@ypas.org.uk
Lisa Nolan
Programme Delivery Manager
(Children and Maternity)
Liverpool CCG
Lisa.nolan@liverpoolccg.nhs.uk

2. Need:
• Approx. 100,000 c&yp
• Liverpool is 1 of the most deprived
cities in UK
• High proportion of LAC, young
cares, c&yp with disabilities, BME
communities and refugee and
asylum seekers
High risk factors therefore mental
health problems likely to be high
Tier
Number
1
12828 (15%)
2
5986
3
1582 (1.85%)
4
64
(7%)
(0.075%)
Main presenting problems:
- Emotional disorders, behavioural
and self harm
Adverse Childhood Experiences:
- physical, emotional, sexual
abuse, domestic violence, household
substance misuse, household mental
illness, parental separation and
divorce, parent in prison
Main referrers:
- Education, child health
services, GP
L4, L8 and L6 postcodes account for
27% of referrals

3. Liverpool’s CAMHS Partnership
•
•
•
•
•
•
•
Needs led
Family centred
Multi-agency – range of providers
Provides continuum of care with targeted support
Engaging, Involving and inclusive
Jointly commissioned
Strong
How did we get here?

4. The journey

5. In-patient
provision
Pre-2003
Alder hey
community
mental health
teams
2+1
service, Al
der hey

6. Providers:
Commissioners:
Outcomes:
Alder hey
Foundation
Trust –
Community
Mental health
teams
Regional
units
Liverpool
Health
Authority
Not monitored
or reported

7. Regional In-patient Units:
2003-2006
SLD team
CAMHS tier 3
community teams,
Working Together
HAVEN
CABI
YPAS counselling
Tier 2
BEST
YPAS Support Service
‘Mad, Bad or Misunderstood’,
AS Pathway

8. Providers:
Commissioners:
Outcomes:


Alder Hey
(many teams)
VCS:
YPAS
Regional
units
Liverpool PCT
Liverpool City
Council





Dev. of choice
Less stigmatising
provision
New ways of
working
More community
based provision
Joint and
partnership
working
Emerging
performance
monitoring
process
Policy driven

9. Regional Home Based
Treatment
Regional In-patient Units:
2007-2010
SLD team
YOS mental health
provision
CAMHS
16-18 team
Working Together
CAMHS tier 3
community teams,
CABI
CAMHS
LAC
YPAS counselling
AS Pathway
HAVEN
BEST
Tier 2
YPAS Support Service
TAMHS, MYA
ADHD Foundation
Participation team,
MYA
Banardos Young Carers &
‘Keeping the Family in Mind’
Training and MH Promotion: ‘Mad, Bad or Misunderstood’,
Healthy schools Partnership, Mental health promotion

10. Providers:
Commissioners:
Outcomes:


Alder Hey
(many teams)
VCS:
YPAS, PSS, B
arnardos, MY
A
Regional
units and
HBT
Liverpool PCT
Liverpool City
Council
Social Care






Dev. of choice
Less stigmatising
provision
New ways of
working
More community
based provision
Joint and
partnership
working participation
Thinking family
Improved
performance
monitoring
process
Policy driven

11. Comprehensive CAMHS Pathways 2010-2013
C&YP
&
Families
Training:
Public
Mental
Health
Self-care,
Website
Mental
Health
promotion
Provider:
voluntary
CAMHS
and c&yp
Universal
services
Tier 4
Dewi Jones
Unit
(0-14)
MBM
Inside Out,
Master class
Mental health
first aid
Specific training
Consultation
& support:
Telephone,
individual,
group
Alder Hey
Single
Point of
Access
Triage
(multiagency)
Provider:
Voluntary CAMHS
Statutory CAMHS
(Primary Mental
Health
Service, Specialist
CAMHS)
Tier 4
YPC
(1418), CHEDS
Tier 4
OAT
(Independ
ent Sector)
Voluntary
Sector CAMHS
(YPAS, ADHDF, PSS,
Banardos YC)
AHCFT 0-16
years
Out of Hours
Psychiatry
Mersey Care 16
plus
care aims methodology
Other services
(signposted)

12. Providers:
Alder Hey
(2 teams with
SPA)
VCS:
YPAS, PSS, B
arnardos, MY
A
Regional
units and
HBT
Commissioners:
 Liverpool
PCT/CCG
• Liverpool
City
Council
• Schools
• Social Care
Outcomes:







Dev. of choice • Single point of
Less
access
stigmatising  Multi-agency
provision
triage and
New ways of
working
working
 More accessible
More
information
community
 Consultation
based provision and training
Joint and
accessible to
partnership
frontline
working provision
participation
Thinking family
Robust
performance
monitoring
process

13. Liverpool’s CAMHS Partnership
Performance Monitoring:
• Activity – CAMHS returns/National data
set/national benchmarking
• Outcomes – CAMHS returns/ CORC
• Quality – CAMHS Returns/ Contract visits /
COR

14. Liverpool’s CAMHS Partnership
CTB structures and CCG Governing Body
MHEWB Partnership Board
MHEWB Operational Delivery Group
(ODG)
FYI
SPA development
IAPT project
Board
Tier 3/4 pathways
Transition
Participation
Equalities
MHP and
Training

15. Liverpool’s CAMHS Partnership
So What??
• Reduction in specialist CAMHS referrals
from 11/12 to 12/13
• 90% of those accessing services
showing improvement in mental health
(CORC)
• 90% high satisfaction with services
(CORC)
• Increase year on year of universal staff
accessing training

16. Liverpool’s CAMHS Partnership
•
•
•
•
•
•
•
All providers using CORC measures- session by
session pilot
VCS all quality assured
Choice of provider
Built local workforce – range of interventions
Strong equalities agenda
Strong participation agenda
Focus on early identification and prevention
IAPT ready

17. Liverpool’s CAMHS Partnership
Challenges:
• Professional hierarchy
• Funding
• Restructure
2 out of 3 overcome!!

18. Liverpool’s CAMHS Partnership
Providers Perspective:
Challenges:
•
•
•
•
•
•
A new way of doing things
Professional snobbery/hierarchy
Competition for Funding
Lack of awareness
No relationships
Phase 2 CYP IAPT Application rejected

19. Liverpool’s CAMHS Partnership
Providers Perspective:
How did we address the challenges?
• Forged relationships (initially commissioner driven)
• Joint development and facilitation of training for the
children’s workforce: Mad, Bad or Misunderstood,
CAMHS Master Class
• Active involvement in the development of the
Comprehensive CAMHS pathway – knowing where
we fit

20. Liverpool’s CAMHS Partnership
The Providers Perspective:
How have we overcome the challenges?
•
•
•
•
•
Joint training opportunities
Collaborative working
Learning from our mistakes
Respect and appreciation for varied disciplines
Relationships, Relationships, Relationships!!

21. Liverpool’s CAMHS Partnership
Providers Perspective:
Where are we now?
• Multi-Agency SPA: supported by Partnership
Agreements and Honorary Contracts
• Working collaboratively to fulfil existing service
requirements
• Working collaboratively to secure new service
development opportunities
• Embracing CYP IAPT and the opportunity for further
service transformation

22. Liverpool CYP IAPT Partnership
Value added strengths to the Partnership:
YPAS:
ADHDF:
Alder Hey:
Liverpool CCG:
Liverpool City Council :
Access, Innovation, MDT and Participation
Creative Pathway Development
Clinical Expertise and Innovation
Involving Patients & Public in all we do
Prioritising the most vulnerable

23. Liverpool’s CAMHS Partnership
The Providers Perspective:
Sustainability:
• Embed CYP IAPT into core practice
• Invest in staff training, recruitment retention –
ensuring right people for the job
• Expansion of CYP IAPT Partnership to meet the needs
of the broader population
• Service transformation will ‘future proof’ our
partnership for changing commissioning priorities
• Data captured to inform future commissioning
priorities

24. Why CYP IAPT in Liverpool?
• Liverpool is a unique city with diverse needs
• Offer CYP and families greater choice
• Improve access to Evidence Based therapies
 Modality
 Locality
 Referral routes
• Improve Health Outcomes of Children and Young People
• Willing to learn from each other
• Belief in the model
• Belief in our Partnership

25. What it will look like ?
Our vision: Virtual Single Point of Access
CHOICE
APPOINTMENT
COMMUNITY
CLINICS
Inappropriate
referral:
signpost
Alder Hey
Partnership
YPAS
Partnership
ADHD
Foundatio
n
Partnershi
p
Psychologica
l Therapies
Support
Services
/ IAG
Training /
Consultation
Specialist
CAMHS
Psychologic
al Therapies
Information
Advice
Guidance
(IAG)
Meaningful and Effective Participation
CYP /
Parent
Programme
s

26. Next steps:
• Recruit back fill to posts (Dec 2013)
• Release supervisors and trainees for training (Jan 2014)
• Service transformation begins:
 Implementation of session by session ROM’s
 Structures and mechanisms in place to address the GIFT
participation priorities
 Delivery of Evidence Based Therapies
 Improved mechanisms / opportunities for self referral
 Improved mechanisms for re-entry into services
• Contribute to local, regional and national opportunities for shared learning
Service transformation will be embedded into the very culture of
our Partnership through regular MDT meetings and the
development of a robust communication strategy.

27. Future Aspirations
Sustainability:
• Embed CYP IAPT into core practice
• Invest in staff training, recruitment retention – ensuring right people
for the job
• Expansion of Partnership to meet the needs of the broader
population
• Service transformation will ‘future proof’ our partnership for
changing commissioning priorities
• Data captured to inform future commissioning priorities
Improved Outcomes:
• Further development of ROM’s
• Investment in IT to enable user friendly session by session
monitoring
• Investment in IM&T systems to enable appropriate data capture
• Utilisation of data to identify need and inform service development
• Children, young people and families at the heart of development
and delivery of services

28. Liverpool’s CAMHS Partnership
WHAT NEXT?

29. Liverpool CAMHS
Outcomes Strategic
Map and Pathway
Improved mental health of
Children & Young People
[& their Families]
Improved Environments
so that Children,
Young People & families can
Thrive
Increased Identification
of C&YP with
early indicators of
distress and risks
Reduction in
Mild to Moderate
Distress
Reduction in the
development of Moderate
To Serve distress
Alder Hey - Specialist
CAMHS
MYA- MHP, training and
engagement
Alder Hey – Early intervention (PMHS) and LAC/CIN
Reduction in
life long distress
In-patient care – Dewi
Jones (alder hey) and
YPC (CWP) and
OATS
YPAS – therapeutic/counselling and support service
PSS – refugee and asylum seekers therapeutic support
ADHD Foundation
Barnardos YC and KFIM
Key:
Delivery- public mental health, early
intervention, targeted
Contracts – LCC
Funding- LCC/CCG/social care/schools
(pooled budget)
Performance managed – LCC
Delivery – specialist
Contracts– CCG
Funding- CCG
Performance managed – CCG
Delivery – In-Patient
(regional)
Contracts– Spec Comm
Funding- CCG top slice
Performance managed –
Spec Comm

30. GAPS:
• Transition – CAMHS to AMHS and Tier 3-4 pathway
• Early years and maternal mental health
• Neuro-developmental problems (ASD and ADHD)
• Mental health promotion
• In balance in access – too many at specialist level
• In balance in funding and therefore delivery – more
focus on specialist than early intervention
• Integration at commissioning level

31. Future Challenges:
•Integrated commissioning – funding
•Integrated care – culture, personalities
•Changing NHS – relationship management
•Economic climate and social determinants

32. Future Opportunities:
• Integrated commissioning and care
• CCG and LCC priorities
• Liverpool’s children and young peoples/whole family
agenda
• Public health changes
• Mental health promotion and FYI developments
(participation)
• Training menu
• Transition
• Research opportunities
• Neuro-developmental pathway
• Datasets
CYP IAPT

33. 2014-2017 strategy:
Joint commissioners
Range – VCS,
independent and
statutorypartnership
UNCRC
Working Together to ensure mental health and emotional wellbeing is
‘Everybodies
Business’

34. Thanks for listening !!!!
Any Questions !!!!!!!
Lindsey Marlton
Lindsey.marlton@alderhey.nhs.uk
Monique Collier
monique@ypas.org.uk
Lisa Nolan
Lisa.nolan@liverpoolccg.nhs.uk