First series of focus groups – what was identified as working well

5.2.1 Transforming access to support

Participants highlighted that those aged under 16 now have a 24 hour crisis service that they never had before. The crisis and home treatment teams are led by senior clinicians and provide a swifter response. It was suggested that signposting had improved, that the skill sets of the staff are higher than before and that clinical delivery is better. Young people are also able to self-refer.

The crisis service was described as responsive and containing, covering acute provision, risk management and signposting, all within an average 72 hours. Signposting or onward referral can include home treatment, the emphasis of which is to prevent admissions through intensive support over up to 6 weeks. All of this is new for the age group 16-18.

Having access to a crisis service was recognized as very positive and did not happen before for those with eating disorders. Evening work and home visits have made a lot of difference to the patient experience. The service is more outward facing and in particular, staff in the Eating Disorder Service (EDS) and LD service, have found it better to work with the young clients in their family unit. Home visiting is beneficial but it takes more time: practitioners cannot see people back to back as they did in 9-5 clinics. A good marker of the benefits of the new ways of working is that there are reportedly fewer eating disorder crisis cases now and fewer DNAs. The inpatient unit takes local and non-local referrals. In the past twelve months, participants reported that local admissions had reduced whereas the non-local had not, indicating that the new service is working. (The picture for under-18s is different) They thought there were also fewer A&E presentations. It was also suggested that:

 FTB is improving access by using more and better triage – although it was also highlighted that there is low capacity generally, for instance psychological therapy has a high number of locum staff and is therefore less stable, has less continuity and, in the opinion of a number of participants, is not as good as it was before. Outreach elements of FTB were also thought to be working well (if not yet widely known about).

 Within FTB, there is more joint working with other teams and no more internal referrals since these have been replaced by the integrated hubs.

 FTB’s ways of working are more collaborative: the whole family, whether parent, step- parent or sibling, can receive a service which is more joined up than in the past; having FTB’s own beds to refer into is better than before and there is funding for a specialist perinatal service that is very timely. Access for young parents also described as “vastly improved.”

 There is positive change as a result of PAUSE and the alternative access route who, participants thought, work really well with the EDS and LD team. The PMHW model is new since FTB and involves consultation, simple intervention, or if complex a referral to a hub. (Though in reality PMHWs hold complex cases because, it was reported, hubs are up to and beyond capacity).

The Access Centre has been central to the new model FTB being able to meet local need. For the EDS, Access is now making appropriate referrals – but EDS can also filter by triage. EDS has someone available all day, a duty worker and telephone triage. With a caseload of 190 (90 more than expected) the duty system is important and helps compliance with standards on waiting times of five days for urgent and two weeks for routine referrals.

The LD service reported putting in a lot of work to build relationships with Access, again finding it challenging at first, with inappropriate referrals and signposting, but having worked through this, described now feeling confident that the right people are receiving a service.

Staff reported more crossover skill sharing and joint working, based on the understanding that not everyone needs to cover the whole age range but it is important to keep up to date and understand the issues.

In terms of communicating about the new model and promoting access, a variety of stakeholders reported that the early set-up phases had looked:

“very promising with lots of consultation with the local population, good and frequent newsletters, an engaging website and easier referral pathways…. The old system was rigid and this looks more flexible” (VCS partner)

However, it was concluded that some of this initial promise appeared to be waning, with communication dropping off (e.g. it was reported that the newsletters had stopped) and concerns emerging about long waiting times, higher thresholds, service capacity overall and more signposting out (discussed later in the chapter).

5.2.2 Self-referral and PAUSE drop-in centre

Good feedback across services for PAUSE drop-in service was noted; people like its informality and the staff are seen as engaging well with clients. Self-referral, including via online avenues, was thought to be an excellent innovation – with more young people now coming forward, e.g., from situations where there is domestic violence and this has widened the scope of the service appropriately.

However, it was also pointed out that there is a balance to be struck between low level support and high level need. At the time of these focus groups, PAUSE reported no particular pattern to presentations, with each day being different. It was also noted that service users can’t see the same person each time at PAUSE as it is drop-in and there are no booked appointments (which most people were thought to be happy with).

Furthermore, an important suggestion at this point in the evaluation was that one PAUSE was not enough and that another is needed to meet all the need/demand. It was also highlighted that neither PAUSE or the Access Centre (which operates 8am – 8pm weekdays and 10am -3pm on Saturday and Sunday) are intervention services and dealing with all the need and demand means the teams have had to learn to be more resilient.

Additionally, a number of participants suggested that more information about what PAUSE does was needed (e.g. some suggested that young people thought it was for crises only) with one stakeholder commenting:

“it could be very good if it had a tighter focus, was clearer what it did or could not do, offered home visits since not every young person is OK coming into the city centre and ensured its staff

were trained and experienced…” (VCS stakeholder)

5.2.3 Team cohesion and working together

A contributor from Worcester reported that it was strange at first to do the same job in different service. In some ways there had not been much change and workers were still using local systems, specifically in the EDS. The main link and interface had been with Access and other than that there has been no appreciable change other than meeting new people at training. Participants suggested that now everyone was FTB, staff in EDS had stopped viewing others as ‘you are Birmingham, you are Worcester’ ; however, there were still some niggles, such as knowing which training was mandatory and access to training records continued to be difficult. Partnership working is discussed more fully later in this chapter and while it has taken time to become embedded, some participants view it as a positive aspect of the new model. One long

term CAMHS professional felt that the positive aspect for them of the partnership model was that they were now more confident in approaching other organisations and creative in setting up new partnerships. An example was given of FTB under 5s, Birmingham City University and the Multiple Births Foundation forming a new partnership with the aim of promoting collaborative research and good practice. This person felt there is an opportunity to ‘go out and create’ rather than sit back and wait for others – partnership is more proactive and outward facing.

In one sector staff feel they have really developed as a team, whereby those with adult training have learned skills for working with under 16s and those qualified in children’s working have developed their expertise with older young people and adults. Teams were full of praise for the Access Centre:

“really helpful, always on the end of the phone and parents are so grateful to have a response and feel reassured.”

One contributor asked “Where did those people go before?”