Data Collection Phase
- Pilot Site Selection
- Priorities for the Data Collection Phase
- What information do clinicians need to collect?
The key aims of the data collection phase of the project are:
- To capture a more complete picture of the work done by clinicians (and therefore its cost)
- To inform the development of a system by which payment for CAMHS is determined according to need
The key questions we are asking in the pilot are:
- Can we predict required resource usage from assessment information? (i.e. can we cluster, and if so, what influences those clusters?)
- Can we identify groups of cases that need similar amounts of resource overall?
- How much input is required by whom to get what outcome?
Our hypothesis is that:
- A combination of severity/impact, complexity and context may predict cluster membership
The current phase of the project involves collecting and analysing key data items to identify predictors of resource need in CAMHS and to develop methods for ‘clustering’ children and young people into needs-based resource groups, according to the amount and type of support they need to achieve a positive outcome. The aim is to develop an algorithm which can provide guidance on likely cluster membership, given an assessment profile.
Having received great interest in the project, we are currently working with 22 sites across England to collect the required information. The sites include a wide range of specialist and non-specialist teams, covering Tier 2 to Tier 4 services. The pilot phase of the project is expected to last for 18 months until Summer 2014.
Clinicians from participating services will record certain information about each case they see (including presenting problems, complexity and contextual information). They will also record all of their clinical activity undertaken on behalf of a child (both direct and indirect work) to identify resource implications, and collect information about outcomes for each case. As the CAMHS PbR pilot aligns closely with the CYP IAPT programme, the information required from pilot sites will be a subset of items from the CYP IAPT data set.
Clinicians involved in the pilots will initially be trained in how to complete the Current View tool, which asks about presenting problems, complexity and contextual factors. The training is aimed at promoting consistency in the way this tool is completed. For more information about the tool and training for clinicians, see the Pilot Site Training Materials page.
At this stage in the pilot we will not be asking clinicians to make cluster allocations, as the development of a reliable clustering tool and associated algorithm is dependent on comprehensive analysis of the data received. Asking clinicians to make a cluster allocation is likely to come into effect in 2014. There are currently four cluster groups in consideration, which have been provisionally named Clinically Meaningful Resource Groups (CMRGs). These have been developed based on analysis of retrospective data and learning from previous work, but may be subject to significant revision and changes following data collection and analysis.
Participation in the CAMHS PbR pilot was on a voluntary basis and all sites were self-nominated for inclusion. The following criteria were then used to select from candidate sites:
- Sites had to be able to support the pilot process (have the necessary IT systems in place or be able to make necessary adaptations; clinician and managerial commitment etc.)
- Represent large and small CAMH services
- Represent urban and rural CAMH services
- Represent all regions in England
- Represent the NHS and the independent sector
- Cover the full range of provision, both outpatient and in-patient
- Prioritisation to ensure inclusion of sufficient specialist services and transition cases (e.g. learning disabilities, eating disorders, psychosis)
- Prioritisation of services collecting or able to collect non-face-to-face activity data.
24 services initially volunteered to take part in the pilot, and in July 2012 19 sites were deemed able to support the pilot process, meaning that nearly 2,000 clinicians and 50,000 cases would potentially be involved in the pilot. The selected pilot sites included NHS and independent providers, and covered the full range of provision, including outpatient and inpatient services.
In December 2012, following a strong level of interest from several additional services, three more pilot sites were welcomed to the project, making a total of 22 sites.
One key focus for the piloting process is identifying the resources provided to the small minority of adolescents with on-going mental health difficulties, who need to be transferred to adult mental health services. The aim is to track the resource use of these young people as they progress through CAMHS in order to better understand this subset of the CAMHS population and to help inform predictions of future resource use at transition.
The pilot will also aim to identify the resource needs of children and young people with learning disabilities and associated mental health problems, focussing particularly on the later transition to AMH services and involvement of educational/other healthcare providers.
Another key purpose of the pilot is to link resource usage with outcomes. Whilst the exact outcome measures have not been prescribed, all participating services will be using outcome measures from the CYP IAPT dataset, and the pilot will draw on the analytic approach being adopted in CYP IAPT.
We are asking clinicians to complete a standardised form (Current View tool) after their first meeting with the CYP, to help us understand the problems, complexities and contextual factors that each child or young person is presenting with. We are then asking that additional forms are completed throughout the work with the CYP as and when understanding of the case changes. This will help us ensure the information we have is up to date and as accurate as possible. You also need to ensure that the form is up to date at case closure and at formal review periods.
We will also be asking clinicians to record both face-to-face (“direct”) activity and indirect/liaison work(e.g. extended telephone calls, networking with other agencies) that they do for a child or young person.It is particularly important for this project that we capture “indirect activity”, as we know that although this is integral to the work of CAMHS, this work is often not recorded and thus not considered when funding services.
We will then use this information, alongside information about outcomes, to develop a better understanding of the amount of resources needed to achieve a positive result for different children within the CAMHS population. We hope to gather enough information from clinicians to be able to develop reliable predictions about the resource needs of different children and young people, with different kinds of presenting problems and complexity and contextual factors. This information may in turn inform how resources can be allocated to achieve optimal effectiveness for CAMHS.