ACCESSING APPROPRIATE
CAMHS IN ESSEX - the Single
Gateway Pilot
Lonica Vanclay, ECC and Karen Egglestone,
Catch 22 – 20th March
Tina Russell, ECC and Michelle Hembling,
The Junction 29th March
Why are we doing this?
Standard 9 of the National Service Framework for
Children, Young People & Maternity Services states:
…’all C&YP from birth to their 18th Birthday who
have mental health problems and disorders
should have access to timely, integrated, high
quality, multi-disciplinary services to ensure
effective assessment, treatment and support
for them and their families’…
The tapestry of CAMHS provision
Tier 2
Tier 3
Targeted
Complex
Counselling (Schools)
Tier 3 NEPFT Team in North
SEPT in South
ECC (LA) CAMHS Tier 2 Team
Group and skills programmes to develop self
esteem and confidence
(Schools & Voluntary Organisations)
Tier 1
CAMHS Family Therapies
Group Therapies
Diagnosis, medication, teaching,
consultation
Communication and Language skills development & Family Support
Universal
Tier 4
Acute
Early Years Provision
Education Psychology Service
Healthy schools
PSHE in schools SEAL
Peer and Learning Mentors
Home School Liaison Workers
Pastoral Teams (Secondary Schools)
Partnership commissioned
and voluntary sector provided
services eg Catch 22, The
Junction, Place2Be, Young
Concern
NEPFT/SEPT
Longview/Poplar in-patient
ward
Brookside in-patient ward
Anti-Bullying Policies and Activities – Schools
Communication and Language skills
Leverton secure children’s home
Health Visitor support
Midwifery Services
Children’s centres / Early years activities / Support
Private provision – spot purchased
Commissioning approach
• Strategic partnership structure – County Joint
Commissioning Committee (ECC/LA, NHS, Schools
Forum) and County CAMHS Partnership (with providers
incl schools, voluntary sector )
• 4 Locality Commissioning and Delivery Boards
• Joint commissioning – health, school and LA £ for Tier 2
some locally commissioned; LA seconded staff to Tier 3.
• Aligned commissioning – schools commission
themselves (and vol sector provide)
• Partnership produced a commissioning toolkit resource
to assist schools with commissioning for emotional
health and wellbeing and Commissioning Support
Officers (LA employed but Schools Forum agreed) to
assist.
Challenges with a Tapestry of
Services
• Resources and capacity…………..
• Sufficient knowledge of all services and
across services
• Developing good working relationships
• Building a comprehensive overview
Involvement of the Voluntary Sector
• By localising commissioning (4 quadrants) and
open tendering in line with a Strategic Approach
agreed by the Partnership of a “tapestry” we
enabled voluntary sector provision.
• We know vol sector is more accessible, flexible
– and wanted them to have a role.
• Structured their focus on early intervention –
built into LA CAMHS Tier 2 teams remit to
support and advise vol sector
Outcomes for Services
• Developed a common highlevel children’s
outcomes framework
• Promote use of SDQ, Outcomes Star or
SOUL with categories of met/positive
change; partly met/no or little change and
not met/negative change
• Collation is a challenge!!
Benefits of voluntary sector
involvement
• Harnesses and maximises different
commissioner resources and provider
expertise
• Choice for users about location and type
on intervention
• Single gateway can direct appropriately
and reduce duplication and ping pong
Challenges with voluntary sector
engagement
• Different provision in different quadrants
• Collating information into a provider
directory for the gateway to use
• Improving awareness of referrers (esp
schools and GPs) and trust/confidence in
the vol sector provision
What is the CAMHS Single Gateway?
• A single referral access point to CAMHS across the
North Essex Cluster (and a similar one in South Essex)
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Simple, efficient, consistent & standardised approach
Streamlining referrals avoiding delays in assessment/treatment
Integrated, promoting cross-agency working
Advice & guidance for referrers
Data collection point to help identify gaps, emerging need etc
• A comprehensive referral screening service which will
signpost/direct referrals to most appropriate CAMHS
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Improved experience for C&YP, families & referrers
Reduction in inappropriate referrals
Reduced inequalities
Based in one building, manned by CAMHS professionals from all
Tiers – voluntary, ECC Tier 2 and Tier 3.
Operational process
• Referrer discusses any concerns about emotional and
mental health of the C&YP with – Parents/Carer and if
appropriate with the C&YP and obtains consent to refer
to CAMHS Single Gateway
• Can phone to discuss
• Refer by email, safe haven fax or post
• Referral screened by a team member and
- if Tier 1/early community Tier 2 – referrer given
information about service for family to contact
- directed straight to appropriate Tier 2 or 3 service
- forwarded to relevant MultiAgency Panel if other
agencies also needed/involved
Why this approach?
• Earlier pilot (BCFPI) of standard screening tool
highlighted benefits of this – less ping pong between
services
• There are benefits in a tapestry of services – choice,
location/access, range of methods - but referrers esp
schools and GPs were confused about where to go
• Wanted to continue to commission and build awareness
of the range of services
• Action research pilot approach
• Existing providers operate (rather than a separate
assessment/referral function) at least initially to help
build understanding across providers/tiers
CAMHS Single Gateway
Expected Outcomes
• Evidence that the MH & Emotional needs of C&YP are
being screened in a consistent way
• Easy, efficient and equitable access to CAMHS when
C&YP need them
• Reduction in inappropriate referrals and ‘ping-pong’
between Tiers
• Greater integration of CAMHS across all Tiers and better
use of resources
• Better levels of support for Referrers
• Identification of service gaps, emerging areas of need to
inform future commissioning
Challenges for Gateway
• Resources and capacity…………..
• Balance local knowledge/relationships with one
centralised service
• Different processes across organisations
complicates and sometimes duplicates data
recording etc
• Interface with Social Care and other single
gateways into services – one single gateway for
all or specialist knowledge/advice
• What level of professional/clinical expertise to
operate the gateway?
Key concluding messages
• Start with building a partnership strategic
framework
• Make time to develop engagement and mutual
understanding and respect
• Recognise strengths and differences (USP) of
each partner and harness them
• Simplify access but build a tapestry of services
• Huge benefits result from a unified approach to
ensuring the most appropriate service for
families and real partnership working
Further Information
Overall Approach:
Lonica Vanclay
Lonica.Vanclay@essex.gov.uk
Gateway:
CAMHS Single Gateway – North Essex
Holmer Court
Essex Street (off Headgate)
Colchester
CO3 3BT
Any Questions?