This Project will refine an already developed outcome orientated CAMH Service through the development of a manual outlining how to implement an Outcome Orientated CAMH Service (OO-CAMHS) that builds on the latest evidence. In addition, the project will develop a training programme and a website.
OO-CAMHS uses a session by session rating scale for how the patient and/or their carer perceives they are doing (Outcome Rating Scale - ORS) and a session by session rating scale for how the patient and/or their carer rates the therapy and therapeutic alliance (Session Rating Scale – SRS).
The ORS results are entered into an excel-based database system providing information on the outcome trajectory for each patient. In addition the database provides outcome information for each clinician and for the service as a whole (such as number of clients seen, average number of sessions, average outcome score at first session and most recent outcome score, effect size of change, comparison with age standardised normative statistics for the ORS in a clinical population – for both currently open and discharged patients).
The ORS and SRS are well-researched clinically based instruments that were developed to translate research findings into practice using clinically pragmatic tools. Each scale is completed with the young person and/or their carers and only takes a minute or two. Using the ORS alerts clinicians to patients at high risk of a poor outcome.
The majority of patients will show improvements within two to five sessions. If there is no improvement after five sessions, then the patient is at high risk of a poor outcome (and getting stuck in long term treatment with little change) and so the case is brought to a team discussion, which can lead to a change of therapeutic approach or change of clinician. If the patient has raised a concern with therapy on the SRS, the patient can indicate to the clinicians what they feel would be needed to address this.
For many clinicians, this approach can seem like a ‘cultural’ challenge to the assumed ‘expertise’ of the clinician as the patient is given a central influence. This means that a ‘whole service’ approach is needed.
Our experience of developing the OO-CAMHS model in the Sleaford and Spalding CAMHS team is that patients like it as their views are always respected and clinicians are ‘won over’ to using it, including the database, as more of their colleagues gain experience, report its benefits and enjoy the creativity and learning provided through regular peer supervision of ‘stuck cases’.
As the database shows which clinicians are or are not using the measures, extra supervision can be provided to address reluctant clinicians concerns.
This system has many advantages over current national approaches to measuring outcome in CAMHS which do not measure session by session, do not measure the alliance and are not designed to improve outcomes, only measure it.
In the short term, this project will ‘formalise’ the use of the OO-CAMHS approach into a manual, training programme and website. In the long term, this will enable CAMHS services nationally and internationally to adopt this model.