There was a largely positive picture regarding the impact of the pilot programme on experiences of referrals from schools to CYPMHS. Across all 4 surveys, well over three- quarters of respondents (78%) agreed or strongly agreed that the pilots had improved their understanding of the referral routes to specialist mental health support for children and young people in their local area. These aggregated results cut across all of the key stakeholder groups for the pilot programme, including schools, NHS CYPMHS, CCGs and other organisations. As such, it is apparent that the pilots achieved – on
average – a heightened level of awareness of pathways across local networks and that these benefits were not confined solely to the joint working between schools and NHS CYPMHS. This is consistent with the qualitative research, which showed that the areas participating in the pilot programme routinely used the opportunity to revisit and refresh how information on pathways and support was shared and disseminated.
As might be anticipated, improved levels of understanding of referral pathways also translated into increased overall levels of satisfaction with referral processes, although these changes were observed to a varying extent between different types of mental health support. Table 4 shows the average (mean) levels of satisfaction with how referrals were handled by different types of mental health services, as reported through the school lead contact survey. When the responses are ranked from 1 (not at all satisfied) to 4 (very satisfied), it is apparent that the scores increased across all 3 types of services. However, the increase was only statistically significant for NHS CYPMHS, using a paired t-test. This increase was highly significant, at the 1% level.
Table 4 Satisfaction with referral handling (school lead contacts) Specialist mental health
support in school NHS CAMHS Other local mental health services
Mean baseline (standard error) 3.46 (0.10) 2.32(0.10) 2.78(0.40)
Mean endline (standard error) 3.58 (0.10) 2.93 (0.12) 3.11 (0.11)
Paired t-statistic –1.14 –4.31*** –0.89
*Significant at the 10% level; **significant at the 5% level; ***significant at the 1% level.
Figure 11 further breaks down the responses on the satisfaction of referral handling by NHS CYPMHS. It shows that there was a marked shift from ‘not very satisfied’ and ‘not at all satisfied’ at baseline to ‘fairly satisfied’ and ‘very satisfied’ by the +10 months stage.
Figure 11Overall, how satisfied are you with the way that referrals to NHS CAMHS were handled, during the past school year? (school lead contacts)
Base: 49 respondents.
By the end of the pilot programme, specialist mental health within the school remained the main ‘go to’ source of support among most schools and received the highest overall (mean) rating of 4.0 regarding the helpfulness of the services or support provided to schools, compared with 3.3 for NHS CYPMHS and 2.8 for other local mental health services30. Increases in mean scores between the baseline and +10 months stage were
small across all 3 types of services, although the increase in mean score from 2.3 to 2.8 for NHS CYPMHS was statistically significant at the 5% level.
The qualitative interviews reinforce the overall pattern of survey findings. While there were substantial variations between pilot sites, the case-study schools frequently reported having better access to information and feedback from NHS CYPMHS,
compared with the arrangements prior to the pilot. Having a single point of contact served to address some of the main areas of dissatisfaction with these processes, pre-pilot, within schools where this was an issue. The pilot was commonly used as an opportunity to challenge the practice of routing referrals via GPs, where it was not a requirement to do so, to ensure the ongoing involvement of schools beyond the initial point of referral, with parental consent and to agree better ways to share information on outcomes.
30 The question was worded as follows: “In your experience, how helpful have you found the following sources of mental health support, for students that have accessed them?” Respondents were asked to score their response on a 5-point scale: 1. Almost always helped, 2. Often helped, 3. Usually neither helped nor made things worse, 4. Often made things worse, 5. Almost always made things worse, D/K.
With regard to the quality of referrals, there is quite clear evidence from the evaluation that the pilot programme contributed towards improvements in the timeliness and appropriateness of referrals and that it helped to prevent inappropriate or
unnecessary referrals within many of the participating areas. While these outcomes are more difficult to quantify, it is notable that well over half of respondents to the 4 combined surveys (59%) agreed or strongly agreed that the pilot programme had brought about improvements to the effectiveness of referral routes that are available to specialist mental health support for children and young people within the local area.
The qualitative evidence provides a more nuanced picture of what these changes looked like in practice. Often, the closer communication and trust between the school and NHS CYPMHS lead contact meant that school staff would ask for advice about a young person that was giving them cause for concern, rather than automatically making a referral. A better understanding of referral pathways, combined with ongoing contact with the NHS CYPMHS worker, helped to calibrate schools’ judgements about when to refer.
31 The Choice and Partnership Approach (CAPA) is a participatory management model within NHS
CAMHS, which is informed by demand and capacity theory, and places an emphasis on user involvement and reinforcement of staff morale and team working.