1 Kate Dalzell, CORC Practice Lead Ben Ritchie, CORC Informatics LeadUpdate from CORC Kate Dalzell, CORC Practice Lead Ben Ritchie, CORC Informatics Lead
2 What to look back on - and look out for -Our report on child- and parent reported outcomes and experience data – and the work it has stimulated Supporting collation and learning from data Defining, identifying and expanding on best practice use of outcome data Dissemination – opportunities to share and to learn from others Applying CORC learning more widely across the system of services supporting child mental health Give a sense of the rich range of work we have underway
3 Child- and Parent-reported Outcomes and Experience from Child and Young People’s Mental Health Services First ever analysis of routinely collected outcomes and experience data from 75 mental health services in England Challenges for analysis include diversity of population, measures, metrics, lack of control groups or comparison data and data quality Published November 2016 The analysis aims to: Advance the understanding of outcomes and experience of children accessing services Highlight challenges and possible ways forward Consider the best ways to measure and capture outcomes in the future
4 Engagement and debate Seminars in Leeds, Birmingham, LondonBlog pieces Response from children and young people Making the findings accessible See our waiting room poster! Language; too genearlised?; hard to know whether to share the data (feeling like a statistic; feeling worried about not achieveing recovery; ethics)
5 Key findings extract – self-report
6 Debates Different ways of measuring and defining changeLanguage: how to talk about getting better How to work with flawed, uncertain, proximate, sparse data Do we have realistic expectations for children and young people’s mental health outcomes? How do we talk about the limitations’ of services? Raw scores; reliable improvement; recovery; reliable recovery CORC believes we need more services and that the right help can change lives. However, we also believe we have to be honest about the limits of what services can do given our current state of knowledge. CORC recommends the findings of this analysis are used to inform discussions involving practitioners, funders, service users, policy makers and others. Key topics for consideration in such facilitated discussions might include the appropriate metrics for considering outcomes and appropriate targets for given metrics. We need acknowledge what is realistic, setting ourselves targets that, whilst they might stretch us, are grounded in what is possible. We must think more clearly about how we support those who are not better having been seen by specialists by widening our conception of what services and support might look like If we are serious about achieving parity of esteem between physical and mental health, we need parity of data. Better quality data on outcomes and experience of mental health services must be facilitated and incentivised to aid review and development of services. To achieve this, leadership focus, improved IT systems, better staff training and stronger incentives may need to be in place.
7 Trajectories over time – SDQ internalising
8 Beginning: focused conversations informed by “recovery” metricsGiven the difficulties you are experiencing, your history and your context I would expect you to have a X% chance of full recovery in terms of A as measured by B by C date. We will look at all ways to help with Y but given your particular history and circumstances the chances of full recovery here are more like X%. However, even if we cannot change things completely, we do find ways to live with these difficulties using strategies we can help you with. Will I recover? Given what you have told me about how things are at the moment, and how things have been in the past, I think we can work together to make you feel substantially better in the next few months. The self-report scale we are using will show us this improvement, but it might not show that your symptoms are completely gone. Often some symptoms remain – for some people this may be some feelings of sadness, for others this may be sleep problems. Even if we cannot change things completely, many people in your position learn ways of coping with these symptoms. W e will focus on what is important to you and review your progress every time we meet on the self-report scale and on the other indicators we have agreed (such as attendance at school, going out with friends). After six meetings we will review how things are going generally. We can then decide if it makes sense to change tack or to end treatment
9 Practice Consider trajectories and end points from the outset
10 Emergent work What Constitutes a Good Outcome? Talking about endingsEvent on 3rd July - Royal Society of Medicine Talking about endings Training now on offer Talking about failure Tony Rousmaniere article, CORC features Using outcome data to inform prognosis, and engage with likely trajectories Research exploring key questions (see later slide) Lets them know we can be honest with each other about the possibility of failure Signals we are taking the gravity of their challenges seriously Helps the client see that they don't need to rescue me - the therapist – from my own insecurities Signals they can't expect me to save them, because I am not superman: encourages some to step up Facilitates expression of painful feelings: when these are recognized, more honest hope can emerge Benefit for therapist Improved self-esteem and self-compassion from a more balanced, realistic view of myself and my work. A shift in focus from worrying if I am a good therapist, to focusing on gradually getting better through continuous deliberate practice. More enjoyment from my work as I am relieved of the impossible pressure to heroically save all of my clients More open and close relationships with colleagues: openly sharing challenges and failures helps us support each other. Tony Rousmaniere, PsyD However, there is a lack of consensus about the types of change that constitute a ‘good outcome’, and an urgent need for better ways of theorising and measuring children’s mental health outcomes. This workshop aims to stimulate an interdisciplinary debate about what constitutes a good outcome in child and adolescent mental health by bringing together speakers from variety of backgrounds. They include academics from: CYP with experience of using mental health services Philosophers Research psychologists Philosophers of science Psychometricians (experts in measures and measurement) Clinical psychologists The aim is to take a step back, and to reconsider how we define and measure mental health and well-being in children, and how insights from the field of philosophy might help us challenge and improve current practice. We hope that attendees will be open to share, listen and learn with and from others throughout the workshop. The workshop will cover: Existing approaches toward conceptualising and categorising outcomes in child and adolescent mental health What do young people with experience of service use consider a good outcome from therapy? Philosophical perspectives on mental health, well-being, and the ability to reliably report on one’s own state of mind. The difference between mental ill-health and wellbeing outcomes Issues and dilemmas around the measurement of child mental health outcomes.
11 Learning from data
12 CORC Research Outcomes for anxiety and depressionJulian Edbrooke-Childs, Victoria Zamperoni and colleagues Mapping trajectories for change over time Elisa Napoleone, Prof Chris Evans and colleagues Who fills in outcome measures Carin Eisenstein and colleagues Predicting outcomes Zachary Cohen and others Impact of complexity factors on outcomes Karolin Krause and colleagues Looking at change in specific symptoms over time Praveetha Patalay and others Roehampton (Chris) Seattle Liverpool (Praveetha)
13 Learning from data Supporting members to submit data to NHS Digital (MHSDS) Analysing member data to support service improvement CORC reports Bespoke analysis We would welcome your feedback on how to continue to make analysis of member data and the wider dataset relevant and valuable Look out for our quickfire survey on data submission and continuing to see interest from (NHS-funded) members in submitting data to CORC [might need some thinking about how best to frame this] We would welcome to hear Let us know In light of this we could say that we would find it useful to hear from members about how we can continue to make the support offered by CORC in regards to data and analysis relevant and valuable.
14 Defining, identifying, building on best practice
15 CORC Accreditation Congratulations to: Bromley Y, and YPAS The first organisations to be awarded CORC Accreditation in outcome and feedback measurement!
16 CORC Best Practice FrameworkStructured process for working towards best practice Whole system self-assessment, staff survey, and improvement plan development Increasingly used for self-review Liverpool partnership; South Staffordshire; Anna Freud National Centre for Children & Families Explain that the Self-Assessment process using the Best Practice Framework was designed to be comprehensively completed as a whole system approach, with Senior leadership support, and involving staff survey, in-depth self-assessment etc. AS this takes around weeks for most organisations we are unable to complete this within the scope of today. However, we will use the Best Practice Framework to outline standards for Best Practice and enable you to think constructively about where any gaps in practice may lie, and therefore where you may best be able to focus energies on returning to your services. We will be using tools to help you undertake a ‘rapid appraisal’ of where your practice currently lies, and you will have the opportunity to develop an Action Plan to take back to your service to support implementation and improvement.
17 Supporting best practice – trainingProgramme of training & learning events across the country – York, London, Manchester, Embedding best practice and use of outcome and feedback measures Choosing and using measures Interpreting outcome data in children and young people’s mental health Now also on offer.. When to stop treatment Sharing and managing outcome data In development Free e-learning on measuring mental wellbeing for less specialist practitioners When, Why and How do Patients Change in Psychological Treatment Dr Wolfgang Lutz, University of Trier Measuring change in child mental health: what the data from CORC can tell us Professor Miranda Wolpert, Anna Freud National Centre for Children and Families How do we know that we have made a difference? Professor Tamsin Ford, University of Exeter ROM: The Dutch perspective Bertine Lahyis, Karakter, and Professor Frits Boer, University of Amsterdam CORC's approach to implementing ROM Kate Dalzell, CORC Implementing Routine Outcome Measures in a charity-delivered counselling services Mick Atkinson and Dr Fiona Pienaar, Place2Be Building a national quality register for CAMHS process and outcome data in Sweden Olle Lindevall, National Registry for Child and Adolescent Psychiatry Sweden
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19 Supporting best practice - disseminationNew website! Regular blogs Information hub An (increasing) outcome measures database Case studies (showcased in our monthly newsletter) Sussex; Northumberland, Tyne and Wear; AFNCCF; Bromley Y; Tees Esk and Wear Valley; Worcestershire; Berkshire
20 Broadening engagementSchools members Associate members CORC Network Growing international membership International Event New member consultation group Developing joint bids Look out for Health Foundation Scaling Up Improvement How, Why and How do Patients Change in Psychological Treatment Dr Wolfgang Lutz, University of Trier ROM: The Dutch perspective Bertine Lahyis, Karakter, and Professor Frits Boer, University of Amsterdam Building a national quality register for CAMHS process and outcome data in Sweden Olle Lindevall, National Registry for Child and Adolescent Psychiatry Sweden 4:thought. Working in schools (EHCAP) HeadStart partnerships; smaller voluntary orgs Urge individuals to join Network – 100s of people signed up Tameside and Glossop Children’s Society Welcome to IWK Healthcare in Canada, CAMH Service in Australia 13 members on the member consultation group and 3 non members: advising on a range of projects and publications. Building young person consultees as well – let us know if your participation groups would have an interest
21 Applying CORC learning more widely across the system of services supporting child mental healthArea approaches to outcome-focus Shared outcome frameworks Looking at different providers’ data together Support to HeadStart – capacity building – using data to improve resilience and emotional wellbeing programme in six area partnerships Kent; Barking, Havering and Redbridge PHE toolkit
22 Resources to help schoolsMental Health and Wellbeing Toolkit for schools School training on measuring wellbeing Support to HeadStart partnerships Wellbeing Measurement Framework for schools and colleges Kent; Barking, Havering and Redbridge PHE toolkit
23 Come and see us in our new offices!Jordan House Brunswick Place London N1 6EB