Transcript in need - YoungMinds

What we have learnt…recap and reflections
BOND Tees Valley Pilot
Workshop 5
12.7.12
This presentation;
•Re-cap on what we have learnt during
workshops
• Barriers and challenges
• Input from the BOND team
• Reflections on the learning
Who has been on the journey
•Commissioners – with a budget and an interest in
supporting CYP emotional and mental health in order
to improve their outcomes i.e. health, education,
welfare, etc
•Providers of not-for-profit services for CYP which
provides therapeutic or psychological interventions,
and/or support to CYP with mental health problems
Why?
•CVSOs have an important role to play and often offer
good access in local communities, to a broad range of
services
•Commissioners need to be confident in the VCS
•CYP mental health is often perceived as statutory
CAMHS’ business – demand for clinical services
outstrips capcity
•Early intervention works and is cost effective
•Schools increasingly engaging in commissioning –
and need to know about VCS services
•Need a broad range of services to meet a broad range
of need
ACCESS TO SERVICES?
Access
1
Service ‘tiers’
4
Access to mental health expertise?
Mental
health
expertise
1
Service ‘tiers’
4
What happens to children and young people?
Mental
health
expertise
Access
GP
School
LA
1
Service ‘tiers’
4
Where does the VCS fit in?
Mediation
D.V.
Activity
based
Mental
health
expertise
Young
Carers
Access
Drop
in
School
Counselling
1
Mental Health
Services
Service ‘tiers’
4
VCSOs Challenges
•
•
•
•
•
Funding
Competition vs partnership
Specialist vs generic
Statutory service domination of partnerships
Capacity to compete –process excludes smaller
organisations or less ‘networked’ VCSOs
• New requirements e.g. PBR, outcome measures
• Business planning on shifting sand– personnel,
policy, environment
• Need for new business approaches – marketing, cost
benefit analysis, etc
Commissioner’s Challenges
• Ensuring services are ‘safe’ and high quality
• Fully understanding the market
• Developing services for the most difficult to reach
groups
• Ensuring timely access to appropriate MH expertise
in the right part of the system
• Identifying best value for money
Schools’ Challenges
• Identifying pupils with a mental health problem and
getting help quickly
• Want to refer directly to CAMHS
• Want information back from services about pupils so that
can help them in school setting
• Knowing what works and the difference between
services
• Services must show an impact on a pupils’ ability to learn
External Environment
-Market and competition
-Commissioning and delivery
system
-Policy and drivers
-MH spectrum/definitions
-Commissioning environment
-Quality assurance
Opportunities
for…
Information gathering & exchange
Identifying critical issues and barriers
Levels of competition in CYP mental health provider market
Numerous providers + commissioners
Large + small organisations
More VCS
Less clinical governance
Smaller contracts
Frequent tendering
Some variety of providers
More frequent tendering +
increasing competition (usually
LAs, NHS)
Infrequent competition amongst
larger MH provider trusts
Limited contestability
Tier 4:
Inpatient Care
Tier 3:
Clinical/ medical
care (diagnosis/
medication)
Tier 3/2 interface:
Primary MH
services
LAC, YOS, other
targeted CAMHS
Tier 2/1 interface:
‘Generic’
School + community
based e.g. counselling +
IAG services
Related services e.g.
drop-in, youth support,
family support
What do we mean by ……
•Emotional wellbeing, mental health, mental disorders?
•Early intervention mental health services?
• Types of interventions
• Settings/age groups
• TaMHS
•Evidence based practice?
Different labels same children
Children at risk;
in need;
vulnerable
Children with emotional
and behavioural difficulties;
special needs
Children with mental illnesses;
psychiatric disorders
Social Care
Education
Health
The mental health spectrum
From: Huppert Ch.12 in Huppert et al.
(Eds) The Science of Well-being
Flourishing
Moderate
mental
health
Languishing
Mental
disorder
Number of symptoms or risk factors
The effect of shifting the mean of the mental health
spectrum
From: Huppert Ch.12 in Huppert et
al. (Eds) The Science of Well-being
Flourishing
Moderate
mental health
Mental disorder
Languishing
Number of symptoms or risk factors
Types of mental health work in schools (from TaMHS national evaluation 2012)
Category
Types of work included
1. Social and emotional skills
development of pupils
2. Creative and physical activity for
pupils
3. Information for pupils
Social and Emotional Aspects of Learning (SEAL) programmes,
Nurture groups and Circle time
drama, music, art, yoga, outward bound activities
4. Peer support for pupils
5. Behaviour for learning and
structural support for pupils
6. Individual therapy for pupils
7. Group therapy for pupils
buddy schemes, peer mentoring
behaviour support, behaviour management, celebrating success,
lunchtime clubs, calm rooms
counselling, cognitive and/or behavioural therapy
interpersonal group therapy, cognitive and/or behavioural therapy
groups
leaflets, advice lines, texting services, internet based information
8. Information for parents
9. Training for parents
10. Counselling/ support for parents
advice lines, leaflets, texting services, internet based information
parenting programmes such as Webster Stratton and Triple P
programmes
individual work for parents, family therapy, family SEAL – can
include children and parents or just parents, or a combination
11. Training for staff
specific training from a mental health professional
12. Supervision and consultation for on-going supervision or advice from a mental health professional
staff
13. Counselling/ support for staff
provision to help staff deal with stress and emotional difficulties
Levels of evidence for intervention studies (from National
Iinstitute of Clinical Excellence)
Level of evidence Type of evidence
1++
High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very
low risk of bias
1+
Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a
low risk of bias
1–
Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias*
2++High-quality systematic reviews of case–control or cohort studies
High-quality case–control or cohort studies with a very low risk of
confounding, bias or chance and a high probability that the relationship is
causal
2+
Well-conducted case–control or cohort studies with a low risk of
confounding, bias or chance and a moderate probability that the
relationship is causal
2–
Case–control or cohort studies with a high risk of confounding bias, or
chance and a significant risk that the relationship is not causal*
3
Non-analytic studies (for example, case reports, case series)
4
Expert opinion, formal consensus
*Studies with a level of evidence ‘–‘ should not be used as a basis for making a
recommendation
What do we mean by ……
•Commissioning (what’s involved? Where does
procurement fit in? CYP participation?)
•Outcomes? Value for money?
Strategic process
for allocating
resources
Identify
needs
Outcomes?
Resources?
Priorities?
What have
we learnt
about needs?
Plan and design
pattern of
services
how well is
the service
delivering
outcomes?
Look to the
market - Does
it provide what
we need?
Tender &
Procure
Disinvest?
Develop
market?
Commissioning practice varies widely…….
Intelligent
Commissioning
Many organisations
operate here
Maximise value from
total local public sector
budget
Effective
Commissioning
 Commissioners
engaging with
communities on the
pattern of services
required
 Commissioners
shaping structure of
delivery
Adequate
Commissioning (status
quo)
 Good control over
existing contracts
Weak Commissioning
 Personalisation
Empowering users and
local communities
Widespread embracing
of behavioural change
Some community led
commissioning
Semi-autonomous
personalisation
Driven by customer
experience
 Decommissioning
 Narrow approach to
commissioning around
procurement and
purchasing
 Historically and provider
led
 Little effective challenge
 Active redesign of
services
Outcome driven
Aiming to be here….
REACTIVE COMMISSIONING
What added value can you offer?
• Volunteer capacity (how cost effective is this?)
• Organisationally held knowledge and expertise
• Non-profit making – will this demonstrably make it
cheaper than the competitor’s?
• Local brand (how strong is your brand? What is the
perception locally?)
• Accessibility and less stigma - how do you
demonstrate the benefit?
• Attract other funding – have you promoted your track
record?
The ACE–Value Commissioning Ready Framework
Twelve compulsory components must all be evidenced to demonstrate the
provider is “commissionable”.
These are spread across:
•
•
•
Accountability
Compliance
Empowerment
... with an opportunity to shine through evidence of added Values
Policy and national drivers
•
•
•
•
•
Increased access to psychological therapies (IAPT)
Payment by Results
DfE – devolved decision making – pupil premium
Funding environment for VCS
Health reforms…
The new health system
Department
of Health
NHS
Public
Health
England
NHS
Commissioning
Board
(Local health
improvement
in LAs)
Monitor
(economic
regulator)
Clinical Commissioning
Group
CQC
(quality)
HealthWatch
Providers
Local authorities (via health &
wellbeing boards)
Local
HealthWatch
External environment…summary
•
•
•
•
The only constant characteristic is change
Competition is increasing
Have to look outside usual funding sources
Some providers are joining together in order to try
and strengthen position of VCS
• Relationships are highly valued and building trust
and reputation remains important
• Communication from and between services and
schools is part of quality provision
External Environment
-Market and competition
-Commissioning and delivery
system
-Policy and drivers
-MH spectrum/definitions
-Commissioning environment
-Quality assurance
Opportunities
for…
Internal Environment
VCSOs… where are
you in this?
Information gathering & exchange
Identifying critical issues and barriers
• Marketing
• Cost effectiveness
• VfM
• Outcomes
Group exercise
• In ‘discipline’ groups
• As a result of the workshop programme;
- what have you been prompted to think
about
- changes you have in mind to make
- any action you have taken already
• Prompts on sheets to help
• Discuss and record main points
Opportunities
for…
Needs &
priorities?
Partnership?
Competition?
Opportunities?
Review
-Market and competition
-Commissioning and delivery
system
-Policy and drivers
-MH spectrum/definitions
-Commissioning environment
-Quality assurance
Internal Environment
VCSOs… where are
you in this?
• Marketing
• Cost effectiveness
• VfM
• Outcomes
Information gathering & exchange
Identifying critical issues and barriers
Local external
environment
•
•
•
•
Participate
Influence
Challenge
Find out
What does this
mean for our…
Vision
Mission
Strategy
Based on Bryson, J. 1988
Organisational
Plan
Based on
strategic plan
Change management
External Environment