G1 Dean Elbe - Redevelopment of Child & Adolescent Mental Health
Child and adolesCent Mental health - King's College London · Child and adolesCent Mental health...
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CHILD AND ADOLESCENT MENTAL HEALTH Research will: • extend into the origins of child mental disorder by studying infants; • implement new technologies, such as near ifrared spectroscopy, eye-tracking and imaging techniques; • extend the data collection on Case Register Interactive Search to include more systematic phenotyping and treatment as usual outcomes, as well as linkage to poulation databases to provide the world’s largest clinical child mental health database; • develop a strategy for routine biomarker collection that will aid deep phenotyping. Education and training will focus on: • implementation of the extended Improving Access to Psychological Therapies to provide core training at a national level; • development of distance learning strategy that considers the full range of training opportunities and programmes. Clinical developments will include: • developing, trialling and evaluating more effective and efficient modalities of assessment and treatment in economically challenging times; • extending the close relationship between research and clinical practice to increase the number of patients participating in research, embed research on service user attitudes and priorities into routine clinical work, and extend the routine systematic data; • developing relationships within the new commissioning arrangements that foster our strategy including evidence-based assessments and interventions, comprehensive services for children and young people with mental disorders, and regional commissioning of specialist services. We plan to maintain an integrated approach to leadership that will deliver these ambitions. Contacts Emily Simonoff, Academic Lead, [email protected] Bruce Clark, Clinical Lead, [email protected] Plans and priorities for the next five years Meeting the tripartite mission Education and training The CAG hosts and contributes to a range of professional training in child and adolescent psychiatry, mental health nursing, clinical psychology, postgraduate trainees in cognitive behavioural therapy, parent training, family therapy, and child and adolescent mental health. New developments include a contract to provide training for the child psychiatry sub-specialty across south London; using feedback from trainees to redesign the medical student teaching programme; the design and pilot of simulation training; use of research training and capacity building component within the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC); expansion of the Department for Education’s implementation programme of evidence-based interventions for children and families; and delivering the Department of Health’s new Children and Young Persons Increasing Access to Psychological Therapies initiative. The CAG has a long history of close ties between university and health services provision, but the establishment of King’s Health Partners has consolidated and intensified the relationship to facilitate these and other developments. Clinical outcomes Our CAG has developed care pathways for assessment and treatment which are now used as the exemplar of best practice nationally by the Department of Health. A central aspect of this has been the incorporation of key outcome measures throughout all assessment and treatment work, which has allowed us to compare our work within the CAG to ensure the dissemination of best practice. The Department of Health data show clear evidence that our treatment approaches are as good as or better than other similarly funded services. We have the largest population-based dataset of treatment outcomes measures. The Department of Health commissioned our CAG as a principle partner to design, develop and pilot the future system of child and adolescent mental health services ‘Payment by Results’ (PbR). This has been developed utilising our comprehensive dataset of fully phenotyped cases. We continue to share our unique data set as PbR is piloted across nearly 60 centres in the UK. Research Overarching strategy: to identify the causes of child mental disorder, develop and evaluate novel interventions and implement evidence-based assessment and treatment. To use a whole-CAG approach to improve the mental health of the community we serve through better diagnosis, prevention in at-risk groups, and personalised treatments that consider the priorities of service users and their families. Our research encompasses the entire translational pathway from basic science studies of the causes of mental disorders through biomarker studies, early phase trials and efficacy/effectiveness trials. All staff in the CAG contribute actively to research in diverse ways, including obtaining ‘consent for contact’ and direct recruitment to research studies. Research income streams (over £6 million in current grants) include the Medical Research Council, Wellcome Trust, EU, NIHR and Departments of Health and Education, as well as more than a dozen smaller charities. Summary The Child and Adolescent Mental Health Clinical Academic Group (CAG) aims to offer comprehensive care for children and young people aged 0-18 presenting with mental disorders. Evidence-based assessments and interventions are delivered at community, secondary and tertiary levels, providing out-, day- and in-patient services to meet the needs of patients. We provide community services for children and young people in Lambeth, Southwark, Lewisham and Croydon and specialist services for London, the region and nationally. Care is closely integrated with the Child Health CAG and other mental health CAGs, with whom we have joint strategies. Routine outcome monitoring is a core element of service delivery. Central to the CAG priorities is achieving the tripartite mission. Clinical academic researchers have programmes that extend from basic science identifying the causes of child mental disorder through evaluations of new diagnostic and treatment modalities. Many of them lead nationally- recognised specialist services providing innovative care. This evidence base is then extended to local services, nationally and globally through multi-professional education and training programmes at all levels. Over the last four years, there has been a culture shift in the CAG with re-alignment of services to meet new research and implementation priorities with local services modifying practice according to scientific findings. Collaboration across the mental-physical interface has extended and involves all components of the tripartite agenda. Examples include joint Child Health /Child Mental Health community clinics in every borough, teaching of psychiatry trainees by colleagues in child health, and shared research projects in eating disorders, neurodevelopment and deliberate self-harm. Research is embedded at every level of the service through consent for contacting and recruiting patients. Academic pre-eminence – We are the only independent academic department of child and adolescent psychiatry in the UK; and we include the greatest number of child psychiatry academics of any institution. Eight of the last nine junior academic trainees have moved to postdoctoral or senior lecturer posts. Our integrated clinical academic teams are international research leaders in autism, ADHD, childhood dementia, eating disorders, OCD and anxiety disorders. Mental-physical interface – This includes: pioneering mental health interventions for childhood dementia; developing psychological treatments for obesity; evaluating new approaches to the treatment of deliberate self-harm; determining the neurodevelopmental and mental health consequences of obstetric complications; and a physical health strategy for children and young people with eating disorders. Innovative models of local healthcare – We are developing and evaluating supported discharge to reduce in-patient stays, and evaluating multi-systemic therapy for antisocial adolescents. We have developed dialectical behaviour therapy for emerging personality disorder to reduce admissions, multi-family groups for eating disorder, and group-based interventions for foster parents. Population health – We have identified the co-occurrence of other mental disorders in autism; demonstrated the high rate of mental disorder in looked-after children; showed that mood problems in young children predict poor outcome in adolescence and adult life; and showed that early trauma affects physical and mental health in later life. Education and training for the healthcare workforce – Our MSc in child and adolescent mental health takes students from over 50 countries. We are transforming the MSc in Family Therapy to accommodate new teaching methods. We have a global intake of clinical students through Maudsley International and we are extending education and training through distance learning. Commissioning – We won one of the five national contracts for specialist autism clinical and research services. Achieving our goals Examples of excellence Innovative model for teaching medical students The CAG has developed an innovative model for teaching medical students. Child psychiatry is a small component of the undergraduate curriculum but it is important that undergraduates appreciate that knowledge of this sub-speciality contributes to a range of areas in medicine, both within and beyond psychiatry. Undergraduates receive a half-day of teaching - two lectures and an interactive tutorial comprised of case vignettes, video material and role-play. A handbook supports the teaching. Undergraduates can undertake their special study component in child psychiatry which is in high demand. They can also gain further expertise in child psychiatry through elective placements, the paediatric summer school and as observers in child psychiatry outpatient clinics and inpatient services. Student feedback is positive and other areas of psychiatry are now considering adopting the model that has been developed by child psychiatry. Student feedback is positive and other areas of psychiatry are now considering adopting the model that has been developed by child psychiatry. Regional specialist commissioning of autism services Our research, undertaken with colleagues from the Child Health CAG, showed that the majority of children with autism have additional mental disorders including ADHD and anxiety that further impair their functioning and quality of life. This finding drove the NICE guidance recommendation that a comprehensive autism assessment should include a mental health evaluation, and contributed to the current NICE guidance (out for consultation) where treatment recommendations consider co-occurring disorders as well as core autism symptoms. It further influenced the specification for autism specialist commissioning within mental health, and we have been awarded one of the contracts. We are now developing a care pathway with colleagues from Child Health to help identify the optimal referral pathway between the two services and to create a shared resource of clinical and research measures.
Transcript of Child and adolesCent Mental health - King's College London · Child and adolesCent Mental health...
Child and adolesCent Mental health
Research will: • extendintotheoriginsofchildmentaldisorderbystudyinginfants;• implementnewtechnologies,suchasnearifraredspectroscopy,eye-trackingand imagingtechniques;• extendthedatacollectiononCaseRegisterInteractiveSearchtoincludemoresystematic phenotypingandtreatmentasusualoutcomes,aswellaslinkagetopoulationdatabasestoprovide theworld’slargestclinicalchildmentalhealthdatabase;• developastrategyforroutinebiomarkercollectionthatwillaiddeepphenotyping.
Educationandtrainingwillfocuson:• implementationoftheextendedImprovingAccesstoPsychologicalTherapiestoprovidecore trainingatanationallevel;• developmentofdistancelearningstrategythatconsidersthefullrangeoftrainingopportunities andprogrammes.
Clinicaldevelopmentswillinclude:• developing,triallingandevaluatingmoreeffectiveandefficientmodalitiesofassessmentand treatmentineconomicallychallengingtimes;• extendingthecloserelationshipbetweenresearchandclinicalpracticetoincreasethenumberof patientsparticipatinginresearch,embedresearchonserviceuserattitudesandprioritiesinto routineclinicalwork,andextendtheroutinesystematicdata;• developingrelationshipswithinthenewcommissioningarrangementsthatfosterourstrategy includingevidence-basedassessmentsandinterventions,comprehensiveservicesforchildrenand youngpeoplewithmentaldisorders,andregionalcommissioningofspecialistservices.
Weplantomaintainanintegratedapproachtoleadershipthatwilldelivertheseambitions.
ContactsEmilySimonoff,AcademicLead,[email protected] BruceClark,ClinicalLead,[email protected]
Plans and priorities for the next five yearsMeeting the tripartite mission
Education and trainingTheCAGhostsandcontributestoarangeofprofessionaltraininginchildandadolescentpsychiatry,mentalhealthnursing,clinicalpsychology,postgraduatetraineesincognitivebehaviouraltherapy,parenttraining,familytherapy,andchildandadolescentmentalhealth.Newdevelopmentsincludeacontracttoprovidetrainingforthechildpsychiatrysub-specialtyacrosssouthLondon;usingfeedbackfromtraineestoredesignthemedicalstudentteachingprogramme;thedesignandpilotofsimulationtraining;useofresearchtrainingandcapacitybuildingcomponentwithintheNationalInstituteforHealthResearch(NIHR)BiomedicalResearchCentre(BRC);expansionoftheDepartmentforEducation’simplementationprogrammeofevidence-basedinterventionsforchildrenandfamilies;anddeliveringtheDepartmentofHealth’snewChildrenandYoungPersonsIncreasingAccesstoPsychologicalTherapiesinitiative.TheCAGhasalonghistoryofclosetiesbetweenuniversityandhealthservicesprovision,buttheestablishmentofKing’sHealthPartnershasconsolidatedandintensifiedtherelationshiptofacilitatetheseandotherdevelopments.
Clinical outcomes OurCAGhasdevelopedcarepathwaysforassessmentandtreatmentwhicharenowusedastheexemplarofbestpracticenationallybytheDepartmentofHealth.Acentralaspectofthishasbeentheincorporationofkeyoutcomemeasuresthroughoutallassessmentandtreatmentwork,whichhasallowedustocompareourworkwithintheCAGtoensurethedisseminationofbestpractice.TheDepartmentofHealthdatashowclearevidencethatourtreatmentapproachesareasgoodasorbetterthanothersimilarlyfundedservices.Wehavethelargestpopulation-baseddatasetoftreatmentoutcomesmeasures.
TheDepartmentofHealthcommissionedourCAGasaprinciplepartnertodesign,developandpilotthefuturesystemofchildandadolescentmentalhealthservices‘PaymentbyResults’(PbR).Thishasbeendevelopedutilisingourcomprehensivedatasetoffullyphenotypedcases.WecontinuetoshareouruniquedatasetasPbRispilotedacrossnearly60centresintheUK.
ResearchOverarchingstrategy:toidentifythecausesofchildmentaldisorder,developandevaluatenovelinterventionsandimplementevidence-basedassessmentandtreatment.Touseawhole-CAGapproachtoimprovethementalhealthofthecommunityweservethroughbetterdiagnosis,preventioninat-riskgroups,andpersonalisedtreatmentsthatconsidertheprioritiesofserviceusersandtheirfamilies.
Ourresearchencompassestheentiretranslationalpathwayfrombasicsciencestudiesofthecausesofmentaldisordersthroughbiomarkerstudies,earlyphasetrialsandefficacy/effectivenesstrials.AllstaffintheCAGcontributeactivelytoresearchindiverseways,includingobtaining‘consentforcontact’anddirectrecruitmenttoresearchstudies.
Researchincomestreams(over£6millionincurrentgrants)includetheMedicalResearchCouncil,WellcomeTrust,EU,NIHRandDepartmentsofHealthandEducation,aswellasmorethanadozensmallercharities.
Summary
TheChildandAdolescentMentalHealthClinicalAcademicGroup(CAG)aimstooffercomprehensivecareforchildrenandyoungpeopleaged0-18presentingwithmentaldisorders.Evidence-basedassessmentsandinterventionsaredeliveredatcommunity,secondaryandtertiarylevels,providingout-,day-andin-patientservicestomeettheneedsofpatients.WeprovidecommunityservicesforchildrenandyoungpeopleinLambeth,Southwark,LewishamandCroydonandspecialistservicesforLondon,the
regionandnationally.CareiscloselyintegratedwiththeChildHealth CAGandothermentalhealthCAGs,withwhomwehavejointstrategies.Routineoutcomemonitoringisacoreelementofservicedelivery.
CentraltotheCAGprioritiesisachievingthetripartitemission.Clinicalacademicresearchershaveprogrammesthatextendfrombasicscienceidentifyingthecausesofchildmentaldisorderthroughevaluationsofnewdiagnosticandtreatmentmodalities.Manyofthemleadnationally-recognisedspecialistservicesprovidinginnovativecare.Thisevidencebase isthenextendedtolocalservices,nationallyandgloballythrough
multi-professionaleducationandtrainingprogrammesatalllevels.Overthelastfouryears,therehasbeenacultureshiftintheCAGwith re-alignmentofservicestomeetnewresearchandimplementationprioritieswithlocalservicesmodifyingpracticeaccordingtoscientificfindings.Collaborationacrossthemental-physicalinterfacehasextendedandinvolvesallcomponentsofthetripartiteagenda.ExamplesincludejointChildHealth/ChildMentalHealthcommunityclinicsineveryborough,teachingofpsychiatrytraineesbycolleaguesinchildhealth,andsharedresearchprojectsineatingdisorders,neurodevelopmentanddeliberateself-harm.Researchisembeddedateveryleveloftheservicethroughconsentforcontactingandrecruitingpatients.
Academic pre-eminence–WearetheonlyindependentacademicdepartmentofchildandadolescentpsychiatryintheUK;andweincludethegreatestnumberofchildpsychiatryacademicsofanyinstitution.Eightofthelastninejunioracademictraineeshavemovedtopostdoctoralorseniorlecturerposts.Ourintegratedclinicalacademicteamsareinternationalresearchleadersinautism,ADHD,childhooddementia,eatingdisorders,OCDandanxietydisorders.
Mental-physical interface–Thisincludes:pioneeringmentalhealthinterventionsforchildhooddementia;developingpsychologicaltreatmentsforobesity;evaluatingnewapproachestothetreatmentofdeliberateself-harm;determiningtheneurodevelopmentalandmentalhealthconsequencesofobstetriccomplications;andaphysicalhealthstrategyforchildrenandyoungpeoplewitheatingdisorders.
Innovative models of local healthcare–Wearedevelopingandevaluatingsupporteddischargetoreducein-patientstays,andevaluatingmulti-systemictherapyforantisocialadolescents.Wehavedevelopeddialecticalbehaviourtherapyforemergingpersonalitydisordertoreduceadmissions,multi-familygroupsforeatingdisorder,andgroup-basedinterventionsforfosterparents.
Population health–Wehaveidentifiedtheco-occurrenceofothermentaldisordersinautism;demonstratedthehighrateofmentaldisorderinlooked-afterchildren;showedthatmoodproblemsinyoungchildrenpredictpooroutcomeinadolescenceandadultlife;andshowedthatearlytraumaaffectsphysicalandmentalhealthinlaterlife.
Education and training for the healthcare workforce–OurMScinchildandadolescentmentalhealthtakesstudentsfromover50countries.WearetransformingtheMScinFamilyTherapytoaccommodatenewteachingmethods.WehaveaglobalintakeofclinicalstudentsthroughMaudsleyInternationalandweareextendingeducationandtrainingthroughdistancelearning.
Commissioning–Wewononeofthefivenationalcontractsforspecialistautismclinicalandresearchservices.
Achieving our goals Examples of excellence
Innovative model for teaching medical students TheCAGhasdevelopedaninnovativemodelforteachingmedicalstudents.Childpsychiatryisasmallcomponentoftheundergraduatecurriculumbutitisimportantthatundergraduatesappreciatethatknowledgeofthissub-specialitycontributestoarangeofareasinmedicine,bothwithin andbeyondpsychiatry.
Undergraduatesreceiveahalf-dayofteaching-twolecturesandaninteractivetutorialcomprisedofcasevignettes,videomaterialandrole-play. Ahandbooksupportstheteaching.Undergraduatescanundertaketheirspecialstudycomponentinchildpsychiatrywhichisinhighdemand. Theycanalsogainfurtherexpertiseinchildpsychiatrythroughelectiveplacements,thepaediatricsummerschoolandasobserversinchild psychiatryoutpatientclinicsandinpatientservices.Studentfeedbackispositiveandotherareasofpsychiatryarenowconsideringadoptingthemodelthathasbeendevelopedbychildpsychiatry.
Student feedback is positive andotherareasofpsychiatryarenowconsideringadoptingthemodelthathasbeendevelopedbychildpsychiatry.
Regional specialist commissioning of autism servicesOurresearch,undertakenwithcolleaguesfromtheChildHealthCAG,showedthatthemajorityofchildrenwithautismhaveadditionalmentaldisordersincludingADHDandanxietythatfurtherimpairtheirfunctioningandqualityoflife.ThisfindingdrovetheNICEguidancerecommendationthatacomprehensiveautismassessmentshouldincludeamentalhealthevaluation,andcontributedtothecurrentNICEguidance(outforconsultation)wheretreatmentrecommendationsconsiderco-occurringdisordersaswellascoreautismsymptoms.Itfurtherinfluencedthespecificationforautismspecialistcommissioningwithinmentalhealth,andwehavebeenawardedoneofthecontracts.WearenowdevelopingacarepathwaywithcolleaguesfromChildHealthtohelpidentifytheoptimalreferralpathwaybetweenthetwoservicesandtocreateasharedresourceofclinicalandresearchmeasures.
