We have been interested in how CAMHS teams organise themselves for a long time. This has included a passion for solving how to deliver high quality services to children and families whilst managing the targets and pressures on us. Both of our services have struggled with long waiting times as well as reduced funding in the context of rising referral rates. These pressures forced our services to be creative and redesign ourselves- some of these changes worked and others didn’t or weren’t sustained.

 

In 2003/4 we did training in demand and capacity theory, Steve from the Modernisation Agency and Ann from the London Learning Partnership and through the National Institute for Mental Health (England, NIMHE) in training in her Trust. We suddenly understood why some of the changes in our services had worked and others hadn’t.

 

We have been privileged in being able to visit other teams around the country in many roles. Some of this has been as colleagues, sharing ideas and practice. At other times it has been more formal. We are both reviewers for the Health and Social Care Advisory Service (HASCAS) and Ann was a clinical governance reviewer for the old Commission for Healthcare Improvement (CHI) and continues to do work with the Healthcare Commission.

 

Both of us are connected to national networks concerned with CAMHS- Steve has been and Ann is the Honorary Secretary of the Faculty of Child and Adolescent Psychiatry of the Royal College of Psychiatrists. Steve was also the Professional Advisor for CAMHS to the DH, England and has recently taken on this role. This has led to many contacts and roles on national working groups and advisory groups. All have helped us in our clinical jobs by understanding issues for grass root services and national directives and how the two can meet.

 

The changes our teams have made have allowed us to spend time reflecting, auditing and understanding what our team had done…but we were frustrated that the wonderful support materials for service redesign that were available nationally were so acute service focussed and not easily translatable to CAMHS.

 

In the summer of 2004 we wrote the 7 HELPFUL Habits of Effective CAMHS to make demand and capacity theory friendly for us and our colleagues. A few months later the Modernisation Agency published ‘10 High Impact Changes for Service Improvement and Delivery’ (NHS Modernisation Agency, 2004). This excellent guide validated our ideas but was still acute service focussed.

 

The first workshops were at the annual conference of Child and Adolescent Psychiatrists in September 2004. These were very popular and we had requests to run a full day. This we did and subsequently had requests to visits regions of the country and whole teams. At the time of writing (August 2006), we have run 20 workshops, including 4 in Scotland funded by HeadsUp. Many have been supported financially by the London Development Centre and local Service Improvement Leads and Regional Development Workers. We have worked with around 200 teams and 1200 staff, including commissioners. We know from staying in touch with people that many teams have been able to change their services.

 

When we started the workshops we concentrated on demand and capacity theory, the 7 HELPFUL Habits and how to use them. But people naturally wanted to know what we had done in our teams and we adapted workshops in response to this curiosity. We linked theory to our own (and others) system changes and described the overarching model- the Choice and Partnership Approach (CAPA). We have published a 1st and now 2nd edition of book which pulled at this thinking together.

 

The demand for thinking about service change has continued and we have run several conferences in New Zealand in 2007 with plans for more and have recently been asked to visit Perth to discuss these ideas.

 

We developed the website in 2005 (and updated in 2007) so that you can find all the tools we describe in the book and information about how other services have managed change and more! Put this address in your favourites list!