Child and Adolescent Mental Health Service (CAMHs) Online
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Abstract
This presentation will describe the development and proof of concept phase of a CAMH service transformation strategy to relocate the assessment and treatment of adolescents from clinics and hospital buildings to cyberspace.
Major financial and practical challenges to the delivery of evidence based mental health assessment and treatment in London are, for the service provider the cost of owning and maintaining extensive real estate that sits empty outside office hours, for the practitioner the money and time spent commuting, and for the patient the cost of travel and the opportunity cost in disrupted schooling and social life. Reducing these financial costs and improving convenience of access are therefore major planning considerations for the CAMH service.
Our mental health service has a well-established Electronic Health Record and more recently has developed a patient portal, MyHealthLocker, using Microsoft’s HealthVault platform to connect service users’, mental health clinicians’ and general practitioners’ records to create a content rich Personal Health Record, controlled by the patient who can choose to grant access to their clinicians and members of their community support network. Using these resources we have created an online care pathway for the assessment and treatment of adolescents with anxiety or depression.
The initial assessment is completed by the young person, parent or carer and teacher, using an evidence based CAMH clinical assessment tool, the Development and Wellbeing Assessment (DAWBA), which integrates the output, calculating probabilities of DSM & ICD disorders.
The patient then books an appointment slot with the CAMH clinician and they meet online, using secure video comms, to review the DAWBA results, complete a mental state examination and agree the formulation, treatment goals, treatment options and plans, and any contingency and crisis plans.
If the problems are straightforward and the condition mild, the patient is directed to online treatment interventions such as MoodGym, supported at agreed intervals by further video contact by the clinician. More severe cases are managed by online CBT, using MyHleathLocker to manage homework and capture session–by-session patient reported outcome measures eg Revised Children’s Anxiety and Depression Scale (RCADS), along with daily mood & event logs.
All UK patients have access to a primary case general practitioner who will evaluate physical health concerns that emerge in treatment. For the small proportion of cases that do not respond to psychological treatment online, for whom clinical review and potentially medication is indicated, they will be seen by the psychiatrist in the community (eg in the school nursing office) in the first instance.
Patient and clinician acceptability measures will be described, along with a narrative of the pertinent organisational cultural issues.
Major financial and practical challenges to the delivery of evidence based mental health assessment and treatment in London are, for the service provider the cost of owning and maintaining extensive real estate that sits empty outside office hours, for the practitioner the money and time spent commuting, and for the patient the cost of travel and the opportunity cost in disrupted schooling and social life. Reducing these financial costs and improving convenience of access are therefore major planning considerations for the CAMH service.
Our mental health service has a well-established Electronic Health Record and more recently has developed a patient portal, MyHealthLocker, using Microsoft’s HealthVault platform to connect service users’, mental health clinicians’ and general practitioners’ records to create a content rich Personal Health Record, controlled by the patient who can choose to grant access to their clinicians and members of their community support network. Using these resources we have created an online care pathway for the assessment and treatment of adolescents with anxiety or depression.
The initial assessment is completed by the young person, parent or carer and teacher, using an evidence based CAMH clinical assessment tool, the Development and Wellbeing Assessment (DAWBA), which integrates the output, calculating probabilities of DSM & ICD disorders.
The patient then books an appointment slot with the CAMH clinician and they meet online, using secure video comms, to review the DAWBA results, complete a mental state examination and agree the formulation, treatment goals, treatment options and plans, and any contingency and crisis plans.
If the problems are straightforward and the condition mild, the patient is directed to online treatment interventions such as MoodGym, supported at agreed intervals by further video contact by the clinician. More severe cases are managed by online CBT, using MyHleathLocker to manage homework and capture session–by-session patient reported outcome measures eg Revised Children’s Anxiety and Depression Scale (RCADS), along with daily mood & event logs.
All UK patients have access to a primary case general practitioner who will evaluate physical health concerns that emerge in treatment. For the small proportion of cases that do not respond to psychological treatment online, for whom clinical review and potentially medication is indicated, they will be seen by the psychiatrist in the community (eg in the school nursing office) in the first instance.
Patient and clinician acceptability measures will be described, along with a narrative of the pertinent organisational cultural issues.
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