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  • Rocks, Stephen  (4)
  • 1
    Online Resource
    Online Resource
    Implementation of significant mental health service change: perceptions and concerns of a mental health workforce in the context of transformation
    Emerald ; 2022
    In:  Journal of Health Organization and Management Vol. 36, No. 9 ( 2022-12-19), p. 66-78
    Details
    In: Journal of Health Organization and Management, Emerald, Vol. 36, No. 9 ( 2022-12-19), p. 66-78
    Abstract: As part of an evaluation of the nationally mandated Child and Adolescent Mental Health Services (CAMHS) “transformation” in one foundation NHS trust, the authors explored the experiences of mental health staff involved in the transformation. Design/methodology/approach The authors employed a qualitative methodology and followed an ethnographic approach. This included observation of mental health staff involved in the transformation and informal interviews (80 h). The authors also undertook semi-structured interviews with key staff members ( n  = 16). Data were analysed thematically. Findings The findings fall into three thematic areas around the transformation, namely (1) rationale; (2) implementation; and (3) maintenance. Staff members were supportive of the rationale for the changes, but implementation was affected by perceived poor communication, resulting in experiences of unpreparedness and de-stabilisation. Staff members lacked time to set up the necessary processes, meaning that changes were not always implemented smoothly. Recruiting and retaining the right staff, a consistent challenge throughout the transformation, was crucial for maintaining the service changes. Originality/value There is little published on the perceptions and experiences of mental health workforces around the CAMHS transformations across the UK. This paper presents the perceptions of mental health staff, whose organisation underwent significant “transformational” change. Staff demonstrated considerable resilience in the change process, but better recognition of their needs might have improved retention and satisfaction. Time for planning and training would enable staff members to better develop the processes and resources necessary in the context of significant service change. Developing ways for services to compare changes they are implementing and sharing good practice around implementation with each other are also vital.
    Type of Medium: Online Resource
    ISSN: 1477-7266
    URL: Article
    DOI: 10.1108/JHOM-06-2021-0205
    Language: English
    Publisher: Emerald
    Publication Date: 2022
    detail.hit.zdb_id: 2109532-2
    SSG: 3,2
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  • 2
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    Online Resource
    How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England
    Public Library of Science (PLoS) ; 2021
    In:  PLOS ONE Vol. 16, No. 5 ( 2021-5-5), p. e0250691-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 5 ( 2021-5-5), p. e0250691-
    Abstract: Child and Adolescent Mental Health Services (CAMHS) in England are making significant changes to improve access and effectiveness. This ‘transformation’ variously involves easier access to services through a Single Point of Access (SPA), more integrated services within CAMHS and enhanced co-provision across education and third sector or non-profit organisations. Methods A mixed-methods observational study was conducted to explore the process and impact of transformation over four years in two services. Ethnographic observations and in-depth interviews were conducted and Electronic Patient Records with over one million contacts analysed. Difference-in-differences analysis with propensity score matching to estimate the causal impact of the transformation on patient access was utilised. Outcomes Spend and staffing increased across both CAMHS. The SPA had growing rates of self-referral and new care pathways were seeing patients according to expected degree of psychopathology. Third sector partners were providing increasing numbers of low-intensity interventions. Although the majority of staff were supportive of the changes, the process of transformation led to service tensions. In the first year after transformation there was no change in the rate of new patients accessing services or new spells (episodes of care) in the services. However, by year three, the number of new patients accessing CAMHS was 19% higher (Incidence Rate Ratio: 1·19, CI: 1·16, 1·21) and the rate of new spells was 12% higher (Incidence Rate Ratio: 1·12, CI: 1·05, 1·20). Interpretation Transformation investment, both financial and intellectual, can help to increase access to CAMHS in England, but time is needed to realise the benefits of reorganisation.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0250691
    DOI: 10.1371/journal.pone.0250691.g001
    DOI: 10.1371/journal.pone.0250691.g002
    DOI: 10.1371/journal.pone.0250691.g003
    DOI: 10.1371/journal.pone.0250691.t001
    DOI: 10.1371/journal.pone.0250691.s001
    DOI: 10.1371/journal.pone.0250691.s002
    DOI: 10.1371/journal.pone.0250691.s003
    DOI: 10.1371/journal.pone.0250691.s004
    DOI: 10.1371/journal.pone.0250691.s005
    DOI: 10.1371/journal.pone.0250691.r001
    DOI: 10.1371/journal.pone.0250691.r002
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    DOI: 10.1371/journal.pone.0250691.r005
    DOI: 10.1371/journal.pone.0250691.r006
    DOI: 10.1371/journal.pone.0250691.r007
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2021
    detail.hit.zdb_id: 2267670-3
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  • 3
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    Online Resource
    Introducing a single point of access (SPA) to child and adolescent mental health services in England: a mixed-methods observational study
    Springer Science and Business Media LLC ; 2020
    In:  BMC Health Services Research Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: In many high-income countries, primary care practitioners are the main point of referral for specialist mental health services. In England, Child and Adolescent Mental Health Services (CAMHS) are increasingly adopting a Single Point of Access (SPA) to streamline referrals and introduce self and parent/carer-referrals. This involves a significant shift of responsibility from primary care towards CAMHS who adopt a more active role as gatekeeper for their service. This study evaluates the adoption of a SPA in CAMHS across a large region in England. Methods We conducted an observational mixed methods study in two CAMHS from January 2018 to March 2019 to evaluate the adoption of a SPA. We collected quantitative data from electronic patient records and qualitative data through ethnographic observation and in-depth interviews of staff and stakeholders with experience of using CAMHS. Additional data on volumes was shared directly from the SPAs and a further snapshot of 1 week’s users was collected. Results A similar SPA model emerged across the two services. Staff were positive about what the model could achieve and access rates grew quickly following awareness-raising activities. Despite the initial focus being on a telephone line, online referrals became the more regularly used referral method. Increased access brought challenges in terms of resourcing, including identifying the right staff for the role of call handlers. A further challenge was to impose consistency on triage decisions, which required structured information collection during the assessment process. Similar to GP referrals, those self-referring via the SPA were mainly from the least deprived areas. Conclusions The introduction of a SPA has the potential to improve young people’s access to mental health services. By addressing some of the barriers to access, simplifying where to go to get help and making it easier to contact the service directly, a SPA can help more individuals and families access timely support. However, the introduction of a SPA does not in itself expand the capacity of CAMHS, and therefore expectations within services and across sectors need to be tempered accordingly. SPA services providing different referral approaches can further improve access for the harder to reach populations.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-020-05463-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2050434-2
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  • 4
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    Online Resource
    Understanding and evaluating new models of Child and Adolescent Mental Health Services in South-East England: a study protocol for an observational mixed-methods study
    BMJ ; 2018
    In:  BMJ Open Vol. 8, No. 12 ( 2018-12), p. e024230-
    Details
    In: BMJ Open, BMJ, Vol. 8, No. 12 ( 2018-12), p. e024230-
    Abstract: Increased demand for Child and Adolescent Mental Health Services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a requirement to transform services to improve accessibility, quality of care and health outcomes. Following the submission of government-mandated transformation plans for CAMHS, services in England are changing in how, where and by whom they are delivered. This protocol describes the research methods to be applied to understand CAMHS transformations and evaluate the impact on the use of mental health services, patient care, satisfaction, health outcomes and health resource utilisation costs. Methods and analysis A mixed-methods approach will be taken in an observational retrospective study of CAMHS provided by a large National Health Service (NHS) mental health trust in South-East England (Oxford Health NHS Foundation Trust). Quantitative research will include descriptive analysis of routinely collected data, with difference-in-differences analysis supplemented with propensity score matching performed to assess the impact of CAMHS transformations from 2015 onwards. An economic evaluation will be conducted from a healthcare perspective to provide commissioners with indications of value for money. Qualitative research will include observations of services and interviews with key stakeholders including CAMHS staff, service users and guardians, to help identify mechanisms leading to changes in service delivery, as well as barriers and enabling factors in this phase of transformation. Ethics and dissemination This project has been registered with NHS Oxford Health Foundation Trust as a service evaluation. Informed consent will be sought from all stakeholders partaking in interviews according to good clinical practice. A local data sharing protocol will govern the transfer of quantitative data. Study findings will be published in professional journals for NHS managers and peer-reviewed scientific journals. They will be discussed in seminars targeting CAMHS providers, managers and commissioners and presented at scientific conferences.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2018-024230
    Language: English
    Publisher: BMJ
    Publication Date: 2018
    detail.hit.zdb_id: 2599832-8
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