What we have learnt…recap and reflections

BOND Tees Valley Pilot

Workshop 5

12.7.12

• Re-cap on what we have learnt during workshops• Barriers and challenges• Input from the BOND team• Reflections on the learning

• Commissioners – with a budget and an interest in supporting CYP emotional and mental health in order to improve their outcomes i.e. health, education, welfare, etc

• Providers of not-for-profit services for CYP which provides therapeutic or psychological interventions, and/or support to CYP with mental health problems

• CVSOs have an important role to play and often offer good access in local communities, to a broad range of services

• Commissioners need to be confident in the VCS• CYP mental health is often perceived as statutory

CAMHS’ business – demand for clinical services outstrips capcity

• Early intervention works and is cost effective• Schools increasingly engaging in commissioning –

and need to know about VCS services• Need a broad range of services to meet a broad range

of need

Access

Service ‘tiers’ 1 4

Mental health expertise




Access GP

LA School



Access

School Counselling

Activity

based

Mediation

Young Carers

D.V.

Drop in

Mental Health Services

• Funding • Competition vs partnership• Specialist vs generic• Statutory service domination of partnerships• Capacity to compete –process excludes smaller

organisations or less ‘networked’ VCSOs• New requirements e.g. PBR, outcome measures• Business planning on shifting sand– personnel,

policy, environment• Need for new business approaches – marketing, cost

benefit analysis, etc

• Ensuring services are ‘safe’ and high quality• Fully understanding the market• Developing services for the most difficult to reach

groups• Ensuring timely access to appropriate MH expertise

in the right part of the system• Identifying best value for money

• Identifying pupils with a mental health problem and getting help quickly

• Want to refer directly to CAMHS• Want information back from services about pupils so that

can help them in school setting• Knowing what works and the difference between

services• Services must show an impact on a pupils’ ability to learn

Opportunities for…

External Environment

-Market and competition-Commissioning and delivery system

-Policy and drivers-MH spectrum/definitions-Commissioning environment-Quality assurance

Information gathering & exchange

Identifying critical issues and barriers

Tier 4: Inpatient Care

Infrequent competition amongst larger MH provider trusts

Some variety of providers More frequent tendering + increasing competition (usually LAs, NHS)

Numerous providers + commissioners Large + small organisations More VCS Less clinical governance Smaller contracts Frequent tendering

Tier 3: Clinical/ medical care (diagnosis/ medication)

Tier 3/2 interface: Primary MH services LAC, YOS, other targeted CAMHS

Tier 2/1 interface: ‘Generic’ School + community based e.g. counselling + IAG services Related services e.g. drop-in, youth support, family support

Limited contestability Increasing levels of competiti

on

• Emotional wellbeing, mental health, mental disorders?

• Early intervention mental health services?• Types of interventions

• Settings/age groups

• TaMHS

• Evidence based practice?

Children at risk;

in need; Social Care

vulnerable

Children with emotional

and behavioural difficulties; Education

special needs

Children with mental illnesses;

psychiatric disorders Health

FlourishingModerate

mental health

LanguishingMental

disorder

From: Huppert Ch.12 in Huppert et al.

(Eds) The Science of Well-being

Number of symptoms or risk factors

Flourishing Moderate mental health Languishing

Mental disorder

From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being

Number of symptoms or risk factors

Category

Types of work included

1. Social and emotional skills development of pupils

Social and Emotional Aspects of Learning (SEAL) programmes, Nurture groups and Circle time

2. Creative and physical activity for pupils

drama, music, art, yoga, outward bound activities

3. Information for pupils advice lines, leaflets, texting services, internet based information

4. Peer support for pupils buddy schemes, peer mentoring 5. Behaviour for learning and structural support for pupils

behaviour support, behaviour management, celebrating success, lunchtime clubs, calm rooms

6. Individual therapy for pupils counselling, cognitive and/or behavioural therapy7. Group therapy for pupils interpersonal group therapy, cognitive and/or behavioural therapy

groups 8. Information for parents leaflets, advice lines, texting services, internet based information

9. Training for parents parenting programmes such as Webster Stratton and Triple P programmes

10. Counselling/ support for parents

individual work for parents, family therapy, family SEAL – can include children and parents or just parents, or a combination

11. Training for staff specific training from a mental health professional 12. Supervision and consultation for staff

on-going supervision or advice from a mental health professional

13. Counselling/ support for staff provision to help staff deal with stress and emotional difficulties

Types of mental health work in schools (from TaMHS national evaluation 2012)

Level of evidence Type of evidence1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with

a very low risk of bias1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with

a low risk of bias1– Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of

bias*2++High-quality systematic reviews of case–control or cohort studies

High-quality case–control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal

2+ Well-conducted case–control or cohort studies with a low risk ofconfounding, bias or chance and a moderate probability that therelationship is causal

2– Case–control or cohort studies with a high risk of confounding bias, orchance and a significant risk that the relationship is not causal*

3 Non-analytic studies (for example, case reports, case series)4 Expert opinion, formal consensus*Studies with a level of evidence ‘–‘ should not be used as a basis for making arecommendation

• Commissioning (what’s involved? Where does procurement fit in? CYP participation?)

• Outcomes? Value for money?

Identify needs

Outcomes?

Plan and design pattern of services

Look to the market - Does it provide what

we need?Tender & Procure

Disinvest?Develop market?

how well is the service delivering

outcomes?

What have we learnt

about needs?

Resources? Priorities?

Strategic process for allocating resources

Weak Commissioning

Historically and provider led

Little effective challenge

Adequate Commissioning (status quo)

Good control over existing contracts

Narrow approach to commissioning around procurement and purchasing

Effective Commissioning

Commissioners engaging with communities on the pattern of services required

Commissioners shaping structure of delivery

Active redesign of services

Personalisation

Decommissioning

Intelligent Commissioning

Maximise value from total local public sector budget

Outcome driven

Empowering users and local communities

Widespread embracing of behavioural change

Some community led commissioning

Semi-autonomous personalisation

Driven by customer experience

Aiming to be here….

Many organisations operate here

REACTIVE COMMISSIONING

• Volunteer capacity (how cost effective is this?)

• Organisationally held knowledge and expertise

• Non-profit making – will this demonstrably make it cheaper than the competitor’s?

• Local brand (how strong is your brand? What is the perception locally?)

• Accessibility and less stigma - how do you demonstrate the benefit?

• Attract other funding – have you promoted your track record?

Twelve compulsory components must all be evidenced to demonstrate the provider is “commissionable”.

These are spread across:

• Accountability• Compliance• Empowerment

... with an opportunity to shine through evidence of added Values

The ACE–Value Commissioning Ready Framework

• Increased access to psychological therapies (IAPT)• Payment by Results• DfE – devolved decision making – pupil premium • Funding environment for VCS• Health reforms…

NHS

NHS Commissioning

Board

Monitor (economic regulator)

Clinical Commissioning Group

Department of Health

CQC (quality)

Providers

Public Health

England

(Local health improvement

in LAs)

Local authorities (via health & wellbeing boards)

HealthWatch

Local HealthWatch

• The only constant characteristic is change• Competition is increasing • Have to look outside usual funding sources• Some providers are joining together in order to try

and strengthen position of VCS• Relationships are highly valued and building trust

and reputation remains important• Communication from and between services and

schools is part of quality provision







Internal Environment

VCSOs… where are you in this?

• Marketing•Cost effectiveness•VfM•Outcomes

• In ‘discipline’ groups• As a result of the workshop programme;

- what have you been prompted to think about

- changes you have in mind to make

- any action you have taken already• Prompts on sheets to help• Discuss and record main points







Internal Environment

VCSOs… where are you in this?

• Marketing•Cost effectiveness•VfM•Outcomes

What does this mean for our…

Rev

iew

Ch

ang

e m

ana

gem

ent

Organisational Plan

Based on strategic plan

Local external environment

• Participate• Influence• Challenge• Find out

Needs & priorities?

Partnership?Competition?

Opportunities?

Based on Bryson, J. 1988

What we have learnt…recap and reflections

Documents

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