3 results
The Pattern of Clinical Activities in Alliance CAMHS Over a 3-Month Period: 2020 vs 2021
- Olajide Adegbite, Tania Saour, Sahar Bhatti
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S80
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- Article
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Aims
This Quality improvement project will look into the data collected over the same period in 2020 and 2021 to highlight patterns and changes as a result of the COVID-19 pandemic, and how to improve the quality of service provided by the team.
MethodsThe record of a total of 349 patients was accessed from the Alliance team spreadsheet and patient electronic records (Rio) between September and November in 2020 and 2021.
The inclusion criteria include:
1. All patients referred to the team
2. All patients managed by the team
3. Patients referred between September and November 2020
4. Patients referred between September and November 2021
Data collected include:
1. Presenting complaint
2. Demographics- gender and race
3. Source of referral
4. Outcome of referral
5. Timeline of first contact after referral
Results1. The overall number of referrals between September and November 2020 was more than referrals over the same time period in 2021; 188 patients in 2020 and 161 in 2021
2. Of the 188 referred in the 2020 audited period, 55%(102) were from minority ethnic groups compared to 50%(80) in the 2021 audited period. So the number and proportion of minorities requiring mental health support rose due to the impact of COVID pandemic infections, restrictions, and lockdowns.
3. In 2020, the proportion of male patients was 26%(49) compared to 18%(30) in 2021. This is important because the majority of our patients are females which implies that the COVID pandemic had a significant effect on the entire population leading to more male patient referrals.
4. The overall number of patients that presented with self-harm was greater in 2020 than in the 2021 period of audit.
5. The overall number of patients that presented with anxiety was also greater in 2020 than in the 2021 period of audit.
6. Of the 188 patients referred between September to November 2020, 58% (109) of them were seen within 24 hours of referral compared to 61% (99) in 2021. In the 2021 period, the restrictions have stopped and it has become far easier to carry out assessments at home and school while using the necessary protective gear.
7. It was noticed that there was a lot of telephone support in 2020 but none in 2021. The majority of these patients were those who were already known to the service and were being supported but deteriorated mentally during the peak of the pandemic.
8. There was a lot of referral from the single point of access (SPA) in between September and November 2020 while there was none over the same time period in 2021. This could have resulted from another impact of the pandemic when a lot of service providers were off sick and their patients could not reach them directly so they opted to go through SPA. Some new referrals also came this way.
9. It is also noteworthy that 59% (112) of patients seen in the 2020 audited period were already known to the service while 54%(88) seen in 2021 were known. This implies that a lot of our patients deteriorated due to the pandemic
10. We also had more new referrals in 2021 than in 2020 for the same audited period.
11. Six percent of the 188 patients seen 2020 audited period had telephone support while none did in 2021. Since all restrictions were lifted in July 2021, the service has opted for a more conventional approach of patient assessment which is face to face especially when expedient.
12. Fifty-two percent (85) of 161 patients seen in the 2021 audited period were signposted to another service while 44% (72) of 188 seen in 2020 were signposted.
ConclusionThis audit has proven that not only did the pandemic affect the overall volume of patients seen, but it also increased the proportion of male patients seen and the relative proportion of minority ethnic groups that used the service.
The pandemic and government policies also influenced how patients were assessed seeing how 2020 had a lot of telephone support.
It's impressive to know that the team managed to cope in these challenging periods without compromising the quality and standard of care as well as leaving behind an up to date medical records making this audit possible and easy
Important Recommendations includes:
1. Completing annual audits on the pattern of clinical activities
2. Continued review of quality and consistency of data collection
3. To consider an alternative method for data collection to minimize the risk of human error.
4. Regular training sessions for mental health crisis team in keeping with changes to mental health presentations during the COVID Pandemic.
5. To review data collected and expand on the information collected to include gender and ethnicity
Transition from child and adolescent mental health services to adult mental health services
- Tania Saour
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S347-S348
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Background
The prevalence and recognition of mental health conditions in young people is growing. Around 50% of lifetime mental illness (except dementia) begins by the age of 14. Around 75% of adults requiring secondary mental health services developed problems prior to 18.
The TRACK study of young people's transitions from CAMHS to AMHS has found that up to a third of teenagers are lost from care during transition and a further third experience an interruption in their care.
A CQUIN for Transition has concluded that young children should have a transition plan 6 months before they turn 18.
MethodAll young people aged 17 and a half years old were included in the data collection for this audit. Clinical information was reviewed using the West London RIO computer system. While reviewing the clinical documentation I was recording whether:
Transitional plans had been discussed with the young person.
If yes, what were they?
Had a referral been made to the appropriate service?
ResultThere were 180 open cases to the Hounslow Adolescent Team. 35 cases were over 18:
At least 16 of these cases needed to be closed as no intervention was being provided.
14 cases had an unclear plan.
Of the 25 cases aged between 17.5 and 18 years of age transitional plans were:
Transition was discussed in 11 cases (44%). This meant that transitional plans were not discussed in 56% of young people.
Of these 11 cases 7 referrals were completed. (28%)
ConclusionThe lack of consistent protocols for transition remains a significant barrier to health care provided to young people.
Transitional planning needs to take place in an effective and timely manner to ensure continued patient centred care.
Transitional discussions to be made a regular agenda item at team meetings.
Care co-ordinator to be informed and reminded that transitional plans need to be explored with young people.
Following a re-audit of this data 6 months on 100% of cases over the age of 18 were closed and transition was discussed in the remaining 56%.
CAMHS Emergency Assessment Service (EAS): development & implementation during the COVID-19 crisis
- Tania Saour, Jovanka Tolmac, Braulio Girelas, William Turton, Lauren Branney
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S55
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- Article
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- You have access Access
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Aims
• To provide emergency psychiatric assessment throughout the COVID-19 pandemic.
• To maintain patient and staff safety by minimising exposure to infection risk by reducing A&E contact.
• To alleviate pressures on the A&E department by enabling CAMHS patients be seen in an alternative setting.
• To provide a more appropriate environment for the assessment of young people in acute distress.
Method• Service live 8th April 2020 to 8th June 2020.
• Exclusion criteria: 1) confirmed/suspected overdose; 2) self-harm with injuries requiring medical attention; 3) acute psychotic episode; 4) drug/alcohol intoxication; 5) high risk of absconding (ASD/LD/LAC), 6) severe agitation/aggression; 7) eating disorders requiring medical intervention; 8) section 136 of the MHA; 9) break down of a social care placement; 10)medically unexplained symptoms.
Data reviewed of all young people who were referred to A&E during March–April 2020. Each case was assessed as to whether they were then seen within the EAS Service.
These cases were reviewed demographically looking at ethnicity, gender, while also reviewing the reason for referral.
Result• A total of 90 cases referred to Urgent Care Team
• Nineteen (21%) met criteria for assessment at EAS
• 80% of presentations between 12am and 9am.
• Commonest reasons for referral : low mood with suicidal ideation (42%), anxiety (26%)
→ 50% service users not previously known to CAMHS
• Majority of service users were female
• Mean age 15 years
• All but one of the young people assessed at the EAS, were discharged home with community follow-up
Conclusion• Average total no. monthly referrals to CAMHS Urgent Care Team (UCT) fell from approx. 90 to 45.
• Only a small proportion of referrals (21%) could be safely seen by the EAS, suggesting that the majority of young people required a joint assessment by A&E and CAMHS Urgent Care Team.
• When need arises, very rapid reconfiguration and implementation of CAMHS emergency services is achievable.
• EAS diverted a small number of young people from exposure to COVID-19 in A & E.
• The service was set up speedily without evaluation of parent/carer/young people views or evaluation of cost-effectiveness.
• If similar services are to be set up permanently, the balance between safety and the risk of division between mental & physical health services and potential to increase stigmatisation of mental illness should be considered.
• Adaptation to future outbreaks should be informed by this initiative.
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