Summary of the impact

The CAMHS team at the University of Northampton have built expertise in CAMHS research that have regional, national and international impact, which has had an influence on regional practice in CAMHS, and through our training initiatives, has had an international reach. A key national priority for mental health service development and delivery for children has been widening access to the service to enable better interaction between specialist and universal services — enabling ease of referral, preventative mental health work, and a smoother experience of service provision for young people entering CAMHS. Expertise at Northampton builds on research evaluating the use of Primary Mental Health Workers (PMHWs) in Youth Offending Teams (YOTs) and with LAC (LAC), as well as research on professional training for mental health professionals more broadly. This research highlighted the importance of joined up working at the interface of primary and specialist services, to young people's access to mental health services, and to increase the responsiveness and appropriateness of these services in meeting young people's needs. Impact includes training of CAMHS workers, through both CPD initiatives and a Masters programme in CAMHS which has trained professionals from the UK and EU, as well as professionals from India and several African countries, who have used this expertise in CAMHS and primary care contexts around the world.

Underpinning research

Callaghan undertook two evaluation studies, exploring the introduction of Primary Mental Health Workers in YOTs (a) and b) below) and in a specialist mental health service for LAC. The PMHW role was originally conceptualised as functioning at the intersection of tier 1 and tier 2 in mental health services, providing liaison, consultation and joint working, to facilitate communication and to improve access for young people between primary care and specialist mental health services. The research focused on the extension of the role of PMHWs in CAMH into contexts with very vulnerable young people with complex mental health and social needs. The research has extended beyond the official completion of the project, through a series of engagements in mental health service development and training initiatives that continue to the present day.

Callaghan undertook the evaluation across the Leicester, Leicestershire and Rutland region. The aim of the research was to explore perceptions of existing CAMHS services for this vulnerable group of young people, to explore barriers professionals and carers experience in gaining CAMHS support for young people, and to evaluate the introduction of a PMHW led service to improve access for young people. The studies involved a series of focus groups with key stakeholders, and with carers, exploring perception of CAMH services for young offenders and looked after young people. Focus groups explored participants' understanding of how young people's mental health needs were met in mental health services. The focus groups identified three key concerns amongst staff working in youth offending, social services and related professions, and amongst carers. These included concerns about access to services (e.g. access purely through GP referral meant that many young people were systematically excluded from services), responsiveness (long waiting lists and slow responses to young people) and appropriateness (service models were generally more appropriate for settled families and were not well adapted to the needs of young people in care and young offenders). These focus groups findings fed into the development of the Young People's Team, in Leicester, Leicestershire and Rutland — a specialist mental health team that focused specifically on the needs of LAC and Young Offenders. The second phase of the study documented and evaluated the work of Primary Mental Health Workers in services for LAC and in YOTs, evidencing the effectiveness of these roles in providing more accessible and responsive services for vulnerable young people. This involved using pre and post intervention measures of mental health difficulties to evaluate the effectiveness of the direct working component of the Young Person's Team, and further focus groups with stakeholders 12 months into the development of the service, to explore their perceptions of the new team. These studies explored the application of the PMHW model in a more specialist context, considering how the same roles might be important in helping young people in `difficult to engage' populations in specialist contexts (YOTs and Social Services) to either receive more specialist help within these teams, or where appropriate to be more easily referred to specialist CAMHS services. Looking at referral patterns, and conducting individual interviews with young people and their carers, the studies established that embedding PMHWs within YOTs, and enabling them to provide a specialist consultation and liaison service through the Young Person's Team improved service access and responsiveness and that this change was valued by young people and their carers.

The research evidenced the effectiveness of embedding Primary Mental Health Workers within YOTs and LAC teams, and this has secured the continuation of and further development of this role in work with socially excluded and vulnerable young people. (1)

References to the research

1) Francis Pace was a psychiatric register at Westcotes House, Leicester, and co facilitated the focus groups for the YOT study

2) Bridgette Young was a senior lecturer in psychology at the University of Leicester. She advised on qualitative analysis

3) Professor Panos Vostanis is Professor of Child Psychiatry at the Greenwood Institute, University of Leicester

4) Maxine Richards was a research associate at the Greenwood Institute, University of Leicester, and acted as co-facilitator in the focus groups with Looked After Children

Details of the impact

The research has produced several key intersecting impacts:

i) Securing of the role of Primary Mental Health Workers in YOTs and LAC's Teams in Leicester, Leicestershire and Rutland.(1)

The most immediate impact of the research was that the role of the PMHW within YOT and LAC was secured in Leicester, Leicestershire and Rutland, as evidenced in the 2002-2009 CAMHS strategy (1). The Young People's Team in Leicester was commended for its accessibility to LAC in the county's 2011-12 Ofsted report.

ii) The model developed here was fed into a network of projects nationally for work by Primary Mental Health Workers working in contexts with difficult to access and difficult to engage populations.

As an outcome of her research on the role of PMHWs, Callaghan participated in a range of initiatives to help develop both the role of Primary Mental Health Worker in CAMHS, and to support appropriate training for this new category of worker.(2) These developments linked directly to research expertise in the PMHW role. Emergent from this network was the development of the PMHW Competency and Capability Framework, issued in April 2005

Dr Callaghan participated in the Primary Mental Health Workers Higher Education Institution network, a network of trainers involved in developing training for PMHWs. The University of Northampton was awarded £25,000 by the DOH to develop specialist training for PMHWs at the University of Northampton. This was seed funding to enable the development of Masters level training for NHS staff who needed to develop the key competencies to work as PMHWs. Dr Callaghan also led training events for PMHWs (some of this was in the previous RAE cycle). The CHIMAT (Child and Maternal Health) training event in Birmingham, at which Callaghan was a keynote speaker, included Primary Mental Health Workers from around the country, and contributed significantly to the development of the PMHW role in CAMHS (3).

iii) Building on our established expertise in Primary Mental Health work, the university is part of a network of Universities and Mental Health service providers, training staff in the NHS to broaden access to mental health services for children and young people. Dr Callaghan is leading the evaluation of this training project, across the Midlands and East of England, and the development of training in Core Competencies in CAMHS. (5)

As CAMHS workforce development has shifted in focus towards the development of an Increasing Access to Psychological Therapies (IAPT) programme, Dr Callaghan has been instrumental in the development of training to support IAPT across the Midlands and East of England, as a steering group member of the Children and Young Persons' IAPT programme. This includes the development of level 6 training for CAMHS staff in working at the tier 1 / tier 2 interface, and leading regional evaluation of IAPT linked initiatives in the Midlands and East of England. (5, 8 and 9)

This project focuses on broadening young people's access to mental health services, embedding evidence based practice in services and developing, and facilitating young people's involvement in service planning and delivery.

25 NHS and Counselling staff have completed the two CPD module in 2013, developing skills in work with children and young people, developing skills in working with young people's mental health needs in primary care contexts. These students have noted that the programme has built their confidence and knowledge in working with children and young people with mental health difficulties who do not currently meet the referral threshold for specialist CAMHS services. (10) A MOOC is in development to broaden the reach of these CPD modules to NHS and other mental health staff round the country.

iv) In Northamptonshire, Dr Callaghan is leading an initiative for the University of Northampton, working in partnership with the Northamptonshire Health Foundation Trust to develop a model for Primary Mental Health Workers to support counselling staff working in schools, and through youth counselling agencies. Funded by the former East Midlands Strategic Health Authority, Dr Callaghan is leading on the development of counsellor training, and evaluating the intervention. She is also a member of the Northamptonshire Young Healthy Minds Partnership Board, which shapes regional policy and commissioning patterns in CAMHS. (4)

This project has significant implications in terms of broadening young people's access to psychological therapies, by providing services to young people with `low threshold' mental health difficulties (low mood, anxiety etc) to intervention. (4) The project is therefore widening access to psychological therapies for young people, and embedding the principles of evidence based counselling and routine outcomes monitoring in work with children and young people.

v) Building on Primary Mental Health training programmes funded by the Department of Health, the University of Northampton has led the development of training programmes for professionals from the UK, EU, Asia and Africa in working with children and adolescents in primary care and early intervention settings.

This training has blossomed into one of the most successful MSc programmes in Child and Adolescent Mental Health in the country, with a broad reaching programme that has trained students from India, China, Southern and East Africa, Sri Lanka and Nepal in the skills needed to provide good quality mental health services for children and young people. (6) Students have built the skills in direct work, consultation and liaison that are key competences for Primary Mental Health Work, and this has impacted positively on their work with children and families, and their career development. (7)

This work is being taken forward through the establishing of a strong collaborative at the University of Northampton, where CAMHS linked research is a growing area of interest. In 2013, Dr Callaghan and the CAMHS team at the University of Northampton convened a three day CAMHS Conference, drawing together practitioners and academic researchers both from around the UK, and internationally. (http://tinyurl.com/camhsconf)

Sources to corroborate the impact

1. Reports to Leicester, Leicestershire and Rutland Councils, and see http://www.leicestercity.nhs.uk/Library/CAMHSStrategy.pdf
2. Statement from former Midlands regional CAMHS policy lead, on Callaghan's participation in the establishment of the PMHWs competence framework, and the development of the PMHW training network.
3. Gale, F. Callaghan, J. and Harrison, P. (2004) Developing the Role of the Child Primary Mental Health Worker in Child and Adolescent Mental Health Services: Commissioning, Service Provision and Training. Invited presentation, CAMHS National Conference, Department of Health. Birmingham NEC, 29 November 2004.
4. Northampton Health Foundation Trust statements (Lead PMHW & CAMHS Commissioner)
5. Statement from Project Manager, Midlands &East Mental Health & Wellbeing Project, and Project website for Midlands and East Mental Health and Wellbeing Project
6. UON Recruitment Data for CPD, MSc CAMH & MSc CAMH PMHW programmes.
7. Statement from MSc CAMH (PMHW) graduate, current CAMHS manager
8. Contract with NHFT and Strategic Health Authority.
9. Contract between University of Northampton and Strategic Health Authority.
10. Evaluation data from the two CPD training modules, including personal statements from participants.