Child and Adolescent Mental Health in Primary Care Contexts
Submitting Institution
University of NorthamptonUnit of Assessment
Psychology, Psychiatry and NeuroscienceSummary Impact Type
HealthResearch Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
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
a) Callaghan, J., Pace, F(1)., Young, B(2).,&Vostanis,
P(3). (2003a). Mental health support for YOTs: a qualitative
study. Health and Social Care in the Community 11(1), 55-63. ISSN:
1365-2524.
b) Callaghan, J., Pace, F., Young, B.,&Vostanis, P. (2003b).
Primary Mental Health Workers within YOTs: a new service model. Journal
of Adolescence 26, 185-199. ISSN: 0140-1971
c) Callaghan, J., Young. B., Pace F., &Vostanis, P. (2004).
Evaluation of a new mental health service for looked after children. Clinical
Child Psychology and Psychiatry, 9, 130-148. ISSN: 1461-7021.
d) Callaghan, J., Young, B., Richards, M(4).,&Vostanis,
P. (2003). Developing new mental health services for looked after
children: a focus group study. Adoption and Fostering,27(4),
51-63. ISSN: 0308-5759
e) Callaghan, J., Young, B., &Vostanis, P. (2004). The mental
health of vulnerable young people, Book chapter in K. Diwedi& P.
Harper(Eds) Preventing Mental Health Problems in Children and
Adolescents. Jessica Kingsley.
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
- Reports to Leicester, Leicestershire and Rutland Councils, and see
http://www.leicestercity.nhs.uk/Library/CAMHSStrategy.pdf
- 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.
- 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.
- Northampton Health Foundation Trust statements (Lead PMHW & CAMHS
Commissioner)
- Statement from Project Manager, Midlands &East Mental Health &
Wellbeing Project, and Project website for Midlands and East Mental
Health and Wellbeing Project
- UON Recruitment Data for CPD, MSc CAMH & MSc CAMH PMHW programmes.
- Statement from MSc CAMH (PMHW) graduate, current CAMHS manager
- Contract with NHFT and Strategic Health Authority.
- Contract between University of Northampton and Strategic Health
Authority.
- Evaluation data from the two CPD training modules, including personal
statements from participants.